Clinical Communication Following a Decision Aid

决策辅助后的临床沟通

• 批准号: 8424694
• 负责人: Margaret M Holmes-Rovner
• 金额: $ 10万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8424694
• 关键词: Clinical; Communication; Following; Decision; Aid

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.

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，因为它从根本上专注于提高临床医生在向患者提供治疗方案时实际使用最新循证信息的程度。局部前列腺癌治疗是偏好敏感决策的典范;患者需要了解权衡，并与治疗医生达成相互可接受的决定。前列腺癌的治疗仍然是令人不安和有争议的，由于缺乏通过积极治疗获得的生存增益和治疗方案之间的泌尿，性和肠道副作用的巨大差异。由于这些生活质量的问题，共同决策（SDM）被广泛推荐。迄今为止，SDM的这一点和其他偏好敏感的决定，主要是通过提供决策辅助（DA）的患者解决。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。在早期前列腺癌中的DA研究发现，患者在与医生会面之前和之后的治疗偏好之间存在差异。然而，到目前为止，研究还没有充分描述的医生和患者之间的交易谁已经审查DA。应用程序的目的是描述，从实际的临床遭遇的录音，泌尿科医生如何提出治疗选择，以衡量在何种程度上发生的共享决策，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级数据分析的录音谈话的转录本泌尿科医生后，活检显示早期前列腺癌。母研究是一项两种决策辅助的随机试验，在四个退伍军人管理局（VA）卫生系统站点进行。患者人群高度多样化，因美国地区以及患者的种族和收入而异。这项研究招募了1,000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对DA准备的早期前列腺癌患者的治疗选择。目的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，更多的SDM在遭遇将增加一致性之间的患者治疗偏好，从遭遇前到遭遇后，作为一个结果，病人-医生的互动。这项研究将在两个主要领域产生重大影响。一个是评估医生在多大程度上履行了告知患者其治疗方案的益处和风险的责任，并评估对患者决策的影响。第二个是提出新的理论方向和实际战略SDM的实施在地面上，直接导致新的方法，医生培训计划。 公共卫生相关性：决定前列腺癌治疗是令人不安和有争议的，因为没有治疗方法可以提高总生存率，但副作用有很大的差异。该项目将分析医生访问和病人的录音 在先前的研究中收集的调查，以1）更好地了解医生和患者如何决定治疗时，患者是充分知情的，2）评估在医生访问对患者的决定的共同决策量的影响。

项目成果

Disease-modifying drugs for multiple sclerosis and subsequent health service use.

• DOI: 10.1177/13524585211063403
• 发表时间: 2022-04
• 期刊: Multiple sclerosis (Houndmills, Basingstoke, England)
• 作者: Ng HS;Zhu F;Kingwell E;Zhao Y;Yao S;Ekuma O;Svenson LW;Evans C;Fisk JD;Marrie RA;Tremlett H
• 通讯作者: Tremlett H