Development of a Patient Decision Aid for Syncope in the Emergency Department: the SynDA Tool.
Development of a Patient Decision Aid for Syncope in the Emergency Department: the SynDA Tool.
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DOI：
10.1111/acem.13373
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Richardson LD
中科院分区：
文献类型：
--
作者：
Probst MA;Hess EP;Breslin M;Frosch DL;Sun BC;Langan MN;Richardson LD
开发一种患者决策辅助工具，以促进因晕厥到急诊室（艾德）就诊的稳定、警觉患者的共同决策。利用患者、临床医生和晕厥、医疗保健设计和共享决策领域专家的输入，我们创建了一个基于纸张的决策辅助原型，用于在对晕厥进行不明显的艾德评估后，让患者参与处置决策（入院与出院）。在第1阶段，我们对10名急诊医生和10名艾德晕厥患者进行了1对1的半结构化探索性访谈。在第2阶段，我们与15名急诊护理临床医生、5名心脏病专家和12名艾德晕厥患者进行了1对1的直接访谈，以获得关于决策辅助内容和设计的详细反馈。我们使用每位受访者的反馈迭代修改援助，直到清晰度和可用性得到优化。这份11 × 17英寸的纸质决策辅助工具名为SynDA，包括4个部分：1）晕厥的解释，2）未来风险的解释，3）个性化的30天风险估计，4）处置选项。使用最近发表的晕厥风险分层工具计算个性化风险估计。该风险估计以自然频率表示，并使用100人彩色编码象形图以图形方式显示。包括以患者为导向的问题，以刺激患者和临床医生之间的对话。在开发过程结束时，患者和医生参与者对决策辅助的清晰度和可用性表示满意。我们反复开发了一种循证决策辅助工具，以促进清醒晕厥患者在无明显艾德评估后的共同决策。需要进一步测试以确定其对患者护理的影响。这种决策辅助有可能改善晕厥患者的护理，促进急诊医学中以患者为中心的护理。
To develop a patient decision aid to promote shared decision-making for stable, alert patients who present to the emergency department (ED) with syncope. Using input from patients, clinicians, and experts in the field of syncope, health care design, and shared decision-making, we created a prototype of a paper-based decision aid to engage patients in the disposition decision (admission vs. discharge) after an unremarkable ED evaluation for syncope. In phase 1, we conducted 1-on-1 semi-structured exploratory interviews with 10 emergency physicians and 10 ED syncope patients. In phase 2, we conducted 1-on-1 directed interviews with 15 emergency care clinicians, 5 cardiologists, and 12 ED syncope patients to get detailed feedback on decision aid content and design. We iteratively modified the aid using feedback from each interviewee until clarity and usability had been optimized. The 11- × 17-inch, paper-based decision aid, titled SynDA, includes 4 sections: 1) Explanation of syncope, 2) Explanation of future risks, 3) Personalized 30-day risk estimate, and 4) Disposition options. The personalized risk estimate is calculated using a recently published syncope risk-stratification tool. This risk estimate is stated in natural frequency and graphically displayed using a 100-person color-coded pictogram. Patient-oriented questions are included to stimulate dialogue between patient and clinician. At the end of the development process, patient and physician participants expressed satisfaction with the clarity and usability of the decision aid. We iteratively developed an evidence-based decision aid to facilitate shared decision-making for alert syncope patients after an unremarkable ED evaluation. Further testing is required to determine its effects on patient care. This decision aid has the potential to improve care for syncope patients and promote patient-centered care in emergency medicine.
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影响因子：
4.4
作者：
Probst, Marc A.;Kanzaria, Hemal K.;Richardson, Lynne D.
通讯作者：
Richardson, Lynne D.
与ED访问有关的晕厥访问相关的资源利用率的国家趋势。
DOI：
10.1016/j.ajem.2015.04.030
发表时间：
2015-08
期刊：
The American journal of emergency medicine
影响因子：
--
作者：
Probst MA;Kanzaria HK;Gbedemah M;Richardson LD;Sun BC
通讯作者：
Sun BC
影响因子：
39.3
作者：
Blanc, JJ;L'Her, C;Mansourati, J
通讯作者：
Mansourati, J
影响因子：
6.2
作者：
Probst, Marc A.;Kanzaria, Hemal K.;Hess, Erik P.
通讯作者：
Hess, Erik P.
影响因子：
4.4
作者：
Baugh, Christopher W.;Liang, Li-Jung;Sun, Benjamin C.
通讯作者：
Sun, Benjamin C.