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，医疗保险和医疗补助服务中心（CMS）要求在报销 一些服务。尽管有这样的要求，我们还没有一种方法来监督医疗质量， 在当今的实践环境中，这一空白限制了需要使用 SDM以及培养SDM或了解其实际效果的能力。在这个应用程序中，我们构建 我们团队的临床和医疗决策专业知识，以开发有效的和心理测量健全， 患者报告的SDM支持（SDM-S）措施，考虑了四个不同的决策阶段（即， 选择意识，考虑备选方案/偏好，做出选择和实施选择），以及 病人用来描述决策过程的语言。在这样做时，我们力求 将SDM测量领域从研究人员、单一尺度方向推进到多相/多个子尺度 明确考虑患者描述的从医生那里获得的决策支持的取向 和不同的护理团队成员在每个决策阶段，从决策意识， 选择实现。随着供应商和其他人探索新的和创新的， 在实践中实施和监测可持续发展机制的方法。我们使用混合方法和以用户为中心的设计方法 在四种偏好敏感的癌症护理环境中制定措施并测试其性能： 肺癌筛查、结肠直肠癌筛查、直肠癌治疗和前列腺癌治疗。 我们评估规模的表现和接受不同的人口服务，在现实世界的小学 和肿瘤护理设置。我们的具体目标是：目标1。发展心理测量学上健全的临床医生特定 和每个决策阶段的整体团队SDM-S分量表;目标2.评估和比较预测 在决策阶段和决策阶段内，临床医生特异性与整体团队SDM-S子量表的有效性; 3.在真实世界的初级和肿瘤护理环境中评价患者对SDM-S量表的可接受性。结果将 能够监控当今基于团队的护理模式中提供的SDM-S的特定阶段质量， 不同的癌症筛查/治疗决策和患者亚组。因此，研究结果将提供 为那些希望监测和改善以患者为中心的护理和重要测量的人提供可操作的目标 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