INFORMED DECISION MAKING IN OLDER PATIENTS AND SURGEONS

老年患者和外科医生的明智决策

• 批准号: 6649194
• 负责人: WENDY LEVINSON
• 金额: $ 36.15万
• 依托单位: NATIONAL OPINION RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6649194
• 关键词: behavioral /social science research tag; clinical research; decision making; developmental psychology; geriatrics; human old age (65+); human subject; informed consent; orthopedics; patient care personnel relations; psychological aspect of aging; satisfaction

DESCRIPTION: As the population ages, elderly patients are confronted with difficult decisions about medical care. Communication between physicians and elderly patients is critical in helping patients make informed choices particularly about major interventions, like surgery. Communication to help patients make informed choices is not only imperative from an ethical and legal perspective, but effective communication between physicians and patients can improve the outcomes of care and patient satisfaction. This proposal builds on prior work by the investigators in which they developed and tested a framework to assess the informed decision-making (IDM) conversations in routine office visits. The proposal is collaboration between the researchers and the American Academy of Orthopedic Surgeons (AAOS), a membership organization of 25,000 surgeons. The specific goals are: 1) To assess the IDM communication skills of practicing orthopedic surgeons during routine office visits with their elderly patients (>65 years). This will be done by audio taping; routine visits with 100 surgeons and 1000 patients in the Chicago area. 2) To evaluate the association between IDM performance, surgeon, patient and visit characteristics. Surgeon characteristics will include a) demographics, b) attitudes toward older patients (ageism), participatory decision-making, and fear of litigation and c) prior communication training. Patient characteristics will include a) demographics (age, gender, race, SES) b) attitudes toward participation in decision making and c) health status. Visit characteristics will include a) length of the visit and b) presence of a third person (child, spouse) in the room. 3) To evaluate the association between surgeons IDM and patient satisfaction. Focus groups of elderly patients will review previously developed IDM criteria and provide input to ensure the criteria are "elder sensitive." 100 orthopedic surgeons' will be recruited and audio taped with 1000 patients (10 per surgeon) in the office setting. Sources of data will include a) the audiotapes, b) surgeon and patient questionnaires. The tapes will be coded to identify each decision and will be rated for the presence or absence of the appropriate IDM criteria. The association between surgeons' IDM performance, surgeon, patient, and visit characteristics will be assessed using hierarchical logistic regression. The study will be the first large data set of actual communication between surgeons and older patients and fills a major gap in knowledge about IDM with the elderly. The study also forms the scientific foundation of a major education initiative by the AAOS designed to improve the communication skills of surgeons and ultimately the care of patients.

描述：随着人口老龄化，老年患者面临着以下问题： 有关医疗护理的艰难决定。医生与医生之间的沟通 老年患者对于帮助患者做出明智的选择至关重要 特别是关于重大干预措施，例如手术。沟通帮助 患者做出明智的选择不仅是出于道德和 法律视角，但医患之间有效沟通 可以改善护理结果和患者满意度。这个提议 建立在研究人员之前的工作基础上，他们开发并测试了 评估知情决策（IDM）对话的框架 例行的办公室访问。该提案是研究人员之间的合作 和美国骨科医师学会 (AAOS) 会员 由 25,000 名外科医生组成的组织。具体目标是： 1）评估IDM 骨科医生日常办公沟通技巧 探访老年患者（>65 岁）。这将通过音频来完成 胶带；在芝加哥对 100 名外科医生和 1000 名患者进行例行访问 区域。 2) 评估 IDM 表现、外科医生、患者之间的关联 及参观特色。外科医生的特征包括： 人口统计学，b) 对老年患者的态度（年龄歧视），参与性 决策、对诉讼的恐惧以及 c) 事先沟通培训。 患者特征包括 a) 人口统计数据（年龄、性别、种族、社会经济地位） b) 对参与决策的态度和 c) 健康状况。 访问特征将包括 a) 访问时长和 b) 存在 房间里的第三人（孩子、配偶）。 3）评估关联 外科医生 IDM 和患者满意度之间的关系。老年人焦点小组 患者将审查之前制定的 IDM 标准并提供意见 确保标准“对老年人敏感”。 100名骨科医生将 在办公室招募 1000 名患者（每位外科医生 10 名）并进行录音 环境。数据来源包括a) 录音带，b) 外科医生和 患者问卷调查。磁带将被编码以识别每个决定并 将根据是否存在适当的 IDM 标准进行评级。这 外科医生的 IDM 表现、外科医生、患者和就诊之间的关联 将使用分层逻辑回归来评估特征。这 研究将是第一个关于实际通信的大数据集 外科医生和老年患者，并填补了有关 IDM 的重大知识空白 老年人。该研究还构成了专业的科学基础 AAOS 旨在提高沟通技巧的教育举措 外科医生的护理，最终是患者的护理。