INFORMED DECISION MAKING IN OLDER PATIENTS AND SURGEONS

描述：随着人口老龄化，老年患者面临 关于医疗护理的艰难决定医生之间的沟通， 老年患者在帮助患者做出知情选择方面至关重要 尤其是关于重大干预的，比如手术沟通帮助 患者做出知情选择不仅是道德上的当务之急， 法律的视角，但医患之间的有效沟通 可以改善护理结果和患者满意度。这项建议 建立在调查人员先前的工作基础上，他们开发和测试了一种 评估知情决策（IDM）对话的框架， 例行办公室访问。这项提议是研究人员之间的合作， 和美国整形外科医师学会（AAOS）， 25，000名外科医生。具体目标是：1）评估IDM 骨科医生日常办公中的沟通技巧 老年患者（>65岁）。这将通过音频完成 录音;在芝加哥与100名外科医生和1000名病人进行例行访问 区2)评价IDM性能、外科医生、患者之间的相关性 参观特色。外科医生特征将包括a） 人口统计学，B）对老年患者的态度（年龄歧视），参与性 决策，害怕诉讼和c）事先的沟通培训。 患者特征将包括a）人口统计学（年龄、性别、种族、SES） B）对参与决策的态度和c）健康状况。 访视特征将包括a）访视时长和B） 第三个人（孩子，配偶）在房间里。3)为了评估协会 外科医生IDM和患者满意度之间的关系。长者焦点小组 患者将审查先前制定的IDM标准，并提供输入， 确保准则“照顾长者需要。“100名整形外科医生将 招募1000名患者（每名外科医生10名）并在办公室进行录音 设置.数据来源将包括a）录音带，B）外科医生和 患者问卷调查。录音带将被编码，以识别每个决定， 将根据是否存在适当的IDM标准进行评级。的 外科医生IDM性能、外科医生、患者和访视之间的关联 将使用分层逻辑回归评估特征。的 这项研究将是第一个大型数据集的实际通信之间 填补了IDM知识的主要空白， 老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 外科医生和最终的病人护理。

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.