Clinical Communication Following a Decision Aid

描述（由申请人提供）：该应用程序是AHRQ比较有效性研究（CER）和价值组合的核心，因为它从根本上关注于提高临床医生在向患者提供有关治疗方案的最新循证信息时实际使用的程度。局部前列腺癌治疗是一个典型的偏好敏感的决定；患者需要了解权衡，并与主治医生达成一个双方都能接受的决定。前列腺癌的治疗仍然是困扰和争议的，因为积极治疗无法获得生存期，而且不同的治疗方案在泌尿、性和肠道方面的副作用存在很大差异。由于这些生活质量问题，共同决策（SDM）被广泛推荐。迄今为止，SDM对这一和其他偏好敏感的决定已经在很大程度上通过向患者提供决策辅助（DAs）来解决。然而，SDM的成功实施需要患者和医生之间关于治疗决策的信息和协作对话以及DA。早期前列腺癌的DA研究发现患者在与医生会面之前和之后的治疗偏好存在差异。然而，到目前为止，研究还没有充分描述医生和病人之间的交易谁已经审查了DA。该应用程序的目的是从实际临床接触的录音中描述泌尿科医生如何提出治疗选择，衡量共同决策发生的程度，并评估SDM对患者决策的影响。该研究是一种混合方法，对泌尿科医生在活检显示早期前列腺癌后的录音对话进行二次数据分析。这项父母研究是一项随机试验，采用两种决策辅助工具，在四个退伍军人管理局（VA）卫生系统站点进行。患者群体高度多样化，因美国地区、种族和患者收入而异。这项研究招募了1000多名男性，其中三分之一患有早期前列腺癌。具体目的是：目的1：描述和评估泌尿科医生在实际决策会议上向DA准备的早期前列腺癌患者提出的治疗选择。目的2：描述、评估共同决策对患者决策的影响，并建立模型。我们的工作假设是，由于医患互动，接触中更多的SDM将增加患者从接触前到接触后的治疗偏好之间的一致性。这项研究将在两个主要领域产生关键影响。一是评估医生在多大程度上履行了告知患者治疗方案的益处和风险的责任，并评估对患者决策的影响。二是为SDM的实际实施提出新的理论方向和实践策略，直接引导医生培训项目的新方法。

DESCRIPTION (provided by applicant): This application is core to AHRQ's Comparative Effectiveness Research (CER) and Value Portfolios, in that it is fundamentally focused on improving the extent to which clinicians actually use up-to-date, evidence-based information about treatment options when it is provided to their patients. Localized prostate cancer treatment is paradigmatic of a preference sensitive decision; patients need to understand the trade-offs and reach a mutually acceptable decision with the treating physician. Prostate cancer treatment remains both troubling and controversial, due to the lack of survival gain obtainable by active treatment and the large differences in urinary, sexual and bowel side effects among treatment options. Due to these quality of life concerns, shared decision making (SDM) is widely recommended. To date, SDM for this and other preference sensitive decisions has been largely addressed through providing patients with decision aids (DAs). However, successful implementation of SDM requires information and collaborative conversations between patients and physicians about treatment decisions as well as a DA. DA studies in early stage prostate cancer have found discrepancies between patient treatment preferences before and after meeting with their physicians. To date, however, research has not adequately described the transaction between physicians and patients who have reviewed a DA. The objective of the application is to describe, from audio recordings of actual clinical encounters, how urologists present treatment choices, to measure the degree to which shared decision making occurs, and to evaluate the impact of SDM on patient decisions. The study is a mixed methods secondary data analysis of transcripts of audio-recorded conversations between urologists following a biopsy showing early stage prostate cancer. The parent study, a randomized trial of two decisions aids, was conducted in four Veterans Administration (VA) health system sites. The patient population is highly diverse, varying by region of the US, and by race and income of patients. The parent study recruited over 1,000 men, one-third of whom had early stage prostate cancer. Specific Aims are to: Aim 1: To describe and evaluate urologists' presentation of treatment choices to DA prepared early stage prostate cancer patients in actual decision encounters. Aim 2: To describe, evaluate, and model the impact of shared decision making on patient decisions. Our working hypothesis is that more SDM in the encounter will increase concordance between patient treatment preferences from pre-encounter to post-encounter as a result of the patient-physician interaction. The study will have a critical impact in two major areas. One is to evaluate the extent to which physicians fulfill their responsibility to inform patients of the benefits and risks of their treatment options and evaluate the impact on patient decisions. The second is to suggest new theoretical directions and practical strategies for SDM implementation on the ground, leading directly to new approaches to physician training programs. PUBLIC HEALTH RELEVANCE: Deciding on prostate cancer treatment is troubling and controversial, because there are no treatments that improve overall survival, but there are large differences in side effects. The project will analyze audio recordings of doctor visits and patient surveys collected in a previous study to 1) better understand how doctors and patients decide on treatment when patients are well informed and 2) to evaluate the impact of the amount of shared decision making in the doctor visit on patients' decisions.