Development of a Shared Decision Making Support (SDM-S) Measure for Use with Team-based Care

摘要 随着医疗保健变得越来越复杂，共享决策(SDM)变得越来越重要 现在需要医疗保险和医疗补助服务中心(CMS)才能报销 一些服务。尽管有这些要求，我们还没有办法监测医疗质量 在今天的实践环境中进行决策。这一空白限制了要求使用 SDM以及培养SDM或理解其在实践中的影响的能力。在此应用程序中，我们构建 依靠我们团队的临床和医疗决策专业知识来开发有效的和心理健康的， 患者报告的SDM支持(SDM-S)措施考虑四个不同的决策阶段(即， 了解选择、考虑备选方案/偏好、作出选择和实施选择)，以及 病人用来描述决策如何在实践中展开的语言。通过这样做，我们寻求 将SDM测量领域从研究人员的单一尺度导向推进到多相/多分尺度 明确考虑患者所描述的从医生那里获得决策支持的方向 和不同的护理团队成员，从决策意识到决策制定的每个阶段 选择实现。当供应商和其他人探索新的和创新的东西时，这样的定位是必要的 如何在实践中实施和监督可持续发展管理。我们使用混合方法和以用户为中心的设计方法 要开发这些指标并测试它们在四种对偏好敏感的癌症护理环境中的表现： 肺癌筛查、结直肠癌筛查、直肠癌治疗和前列腺癌治疗。 我们评估了在现实世界初选中服务的不同人群的规模、绩效和可接受性 和肿瘤学护理环境。我们的具体目标是：目标1.开发临床医生专用的心理测量学 和总体团队SDM-S每个决策阶段的子量表；目标2。评估和比较预测 临床医生专用与整体团队SDM-S决策阶段和决策阶段内的效度； 3.评估SDM-S量表在现实世界的初级和肿瘤护理环境中的患者可接受性。结果将 实现对SDM的阶段特定质量的监控-S在当今基于团队的护理模式中提供 不同的癌症筛查/治疗决定和患者分组。因此，研究结果将提供 希望监控和改进以患者为中心的护理和重要测量的人的可操作目标 为那些研究SDM对患者和其他结果的影响的人提供工具。 1

Abstract As health care has become more complex, shared decision making (SDM) becomes increasingly important and is now required by the Centers for Medicare and Medicaid Services (CMS) prior to reimbursement for some services. Despite such requirements, we do not yet have a way to monitor the quality of medical decision-making in today’s practice environment. This void limits the impact of policies requiring the use of SDM as well as the ability to either foster SDM or understand its effects in practice. In this application, we build on our team’s clinical and medical decision-making expertise to develop valid and psychometrically sound, patient-reported SDM-support (SDM-S) measures that consider four distinct, decision-making phases (i.e., choice awareness, consideration of alternatives/preferences, choice-making, and choice implementation), and the language used by patients to describe how decision making unfolds in practice. In so doing, we seek to advance the SDM measurement field from a researcher, single scale orientation to a multiphase/multi subscale orientation that explicitly considers the decision-making support patients describe receiving from their physician and different care team members across each of the decision-making phases from decision awareness to choice implementation. Such an orientation is needed as providers and others explore new and innovative ways to implement and monitor SDM in practice. We use mixed-method and user-centered design approaches to develop the measures and test their performance across four preference-sensitive cancer care contexts: lung cancer screening, colorectal cancer screening, rectal cancer treatment, and prostate cancer treatment. We evaluate scale performance and acceptability among the diverse populations served in real-world primary and oncology care settings. Our specific aims are to: Aim 1. Develop psychometrically sound clinician-specific and overall team SDM-S subscales for each decision phase; Aim 2. Evaluate and compare the predictive validity of the clinician-specific vs. overall team SDM-S subscales across and within decision phases; and Aim 3. Evaluate patient acceptability of SDM-S scales in real-world primary and oncology care settings. Results will enable monitoring the phase-specific quality of SDM-S provided within today’s team-based care models across diverse cancer screening/treatment decisions and patient subgroups. As such, study findings will provide actionable targets for those wanting to monitor and improve patient-centered care and important measurement tools for those studying the impact of SDM on patient and other outcomes. 1