INFORMED DECISION MAKING IN OLDER PATIENTS AND SURGEONS

描述：随着人口老龄化，老年患者面临着 关于医疗保健的艰难决定。医生与医生之间的沟通 老年患者在帮助患者做出知情选择方面至关重要 尤其是像手术这样的重大干预措施。沟通以提供帮助 患者做出明智的选择不仅是出于伦理和道德的要求 法律视角，但医生和患者之间的有效沟通 可以提高护理结果和患者满意度。这项建议 建立在调查人员之前的工作基础上，在这些工作中，他们开发和测试了 评估知情决策(IDM)对话的框架 例行的办公室访问。这项提议是研究人员之间的合作 和美国整形外科医生学会(AAOS)，成员 组织了25,000名外科医生。具体目标是：1)评估IDM 骨科实习医生日常办公中的沟通技巧 看望他们的老年病人(&gt；65岁)。这将通过音频完成 录音；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绩效、外科医生、患者之间的关系 和参观特色。外科医生的特点将包括) 人口统计学，b)对老年患者的态度(年龄歧视)，参与性 决策，以及对诉讼的恐惧，以及c)事先的沟通培训。 患者特征将包括a)人口统计数据(年龄、性别、种族、社会经济状况) B)对参与决策的态度和c)健康状况。 访问特征将包括a)访问的时间长度和b)a)存在 房间里的第三人称(孩子、配偶)。3)对协会进行评估 外科医生IDM和患者满意度之间的关系。老年人的焦点群体 患者将审查以前制定的IDM标准，并提供意见 确保标准是“老年人敏感的”。100名整形外科医生将 在办公室招募了1000名患者(每个外科医生10名)，并进行了录音 布景。数据来源将包括a)录音带，b)外科医生和 病人问卷。录像带将进行编码，以识别每个决定和 将根据是否存在适当的IDM标准进行评级。这个 外科医生的IDM表现、外科医生、患者和就诊之间的关系 特征将使用分层Logistic回归进行评估。这个 研究将是第一个大型数据集之间的实际交流 外科医生和老年患者，填补了对IDM认识的一个主要空白 老年人。这项研究也构成了一个专业的科学基础 AAOS旨在提高沟通技能的教育倡议 外科医生，最终是病人的护理。

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.