Clinical Communication Following a Decision Aid

描述(由申请人提供)：该应用程序是AHRQ的比较有效性研究(CER)和价值组合的核心，因为它从根本上专注于改善临床医生在向患者提供治疗方案时实际使用最新的、基于证据的信息的程度。前列腺癌的局部治疗是偏好敏感决定的典范；患者需要了解权衡，并与治疗医生达成双方都能接受的决定。前列腺癌的治疗仍然是令人担忧和有争议的，因为积极的治疗缺乏生存收益，而且不同的治疗方案在尿路、性和肠道副作用方面存在很大差异。由于这些对生活质量的担忧，共享决策(SDM)被广泛推荐。到目前为止，对于这一和其他偏好敏感决定的SDM主要是通过为患者提供决策辅助(DA)来解决的。然而，SDM的成功实施需要患者和医生之间关于治疗决定的信息和协作对话以及DA。DA对早期前列腺癌的研究发现，患者在与医生会面前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审查了DA的患者之间的交易。该应用程序的目标是从实际临床接触的音频记录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。这项研究是一项混合方法的二次数据分析，对泌尿科医生之间在活检显示早期前列腺癌后的录音对话的文字记录进行分析。母研究是一项关于两种辅助决策的随机试验，在退伍军人管理局(VA)的四个医疗系统站点进行。患者群体高度多样化，根据美国地区、种族和患者收入的不同而不同。母公司的研究招募了1000多名男性，其中三分之一患有早期前列腺癌。具体目标是：目标1：描述和评估泌尿科医生在实际决策中向DA准备的早期前列腺癌患者介绍治疗选择的情况。目标2：描述、评估和模拟共享决策对患者决策的影响。我们的工作假设是，由于患者-医生的相互作用，相遇中更多的SDM将增加从相遇前到相遇后患者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他们的责任，告知患者他们的治疗方案的好处和风险，并评估对患者决策的影响。第二是为实地实施SDM提出新的理论方向和实践战略，直接导致医生培训计划的新方法。 公共卫生相关性：决定前列腺癌的治疗是令人担忧的，也是有争议的，因为没有任何治疗方法可以提高总体存活率，但副作用存在很大差异。该项目将分析医生就诊和患者的音频记录 在以前的一项研究中收集的调查，以1)更好地了解医生和患者如何在患者知情的情况下决定治疗，以及2)评估医生就诊中共同决策的数量对患者决策的影响。

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.