eCoach: Development and pilot testing of a decision aid for prostate cancer

描述（由申请人提供）：虽然患者的偏好是选择最佳治疗的关键，但患者偏好和所接受的护理之间存在差异。这些缺点威胁到患者的自主权，使患者的安全处于危险之中，并导致昂贵和不必要的治疗。共享决策（SDM）可以更好地协调患者的偏好和所接受的护理。在SDM中，患者和提供者形成伙伴关系，根据最佳可用证据做出决定，该证据根据患者的价值观，偏好和医疗保健目标进行加权。然而，SDM未得到充分利用，现有的工具，以促进它（称为决策辅助）是不够的，忽视了数以百万计的美国人，包括那些有限的健康素养的需求。模拟会话代理（ECA）是模拟面对面会话的计算机动画角色，可用于促进SDM。这些工具在健康知识有限的患者中可能特别有用，因为可能比其他计算机界面更容易使用。此外，这些代理接口可以克服其他方法的被动限制，促进主动学习和决策，为患者提供独立于提供者的关键信息，并允许有关风险和收益的内容的个性化。该项目团队由一个多学科团队组成，擅长ECA的开发，临床研究和前列腺癌男性的决策。对于目标1，我们将使用以用户为中心的设计过程，重点小组和迭代的可用性测试，以开发一个易于使用和广泛接受的技术，跨越文化水平。对于目标2，我们将进行一项试点临床试验，t检验该软件可以减少前列腺癌患者决策冲突的假设，这是决策辅助研究中广泛使用的结果。通过这一建议，我们的目标是满足迫切需要以病人为中心的护理男性前列腺癌。临床获益的证明将为未来的研究奠定基础，研究对重要患者亚组（如健康素养有限的患者）的影响，并研究将此类工具纳入临床工作流程。最终，我们设想了一种工具，可以推广到许多其他情况，并可以改变数百万患者的共同决策过程。

DESCRIPTION (provided by applicant): Although patient preference is critical to selecting the optimal treatment, research discrepancies between patient preferences and care received. These shortcomings threaten patient autonomy, place patient safety at risk, and lead to costly and unnecessary treatments. Shared decision-making (SDM) can lead to better alignment of patient preferences and care received. In SDM, patients and providers form a partnership to make a decision based on the best available evidence that is weighted according to the patient's values, preferences, and healthcare goals. However, SDM is underutilized and available tools to facilitate it (called decision aids) are inadequate overlooking the needs of millions of Americans including those with limited health literacy. Embodied conversational agents (ECA) are computer animated characters that simulate face-to-face conversation and could be used to facilitate SDM. These tools may be particularly useful among patients with limited health literacy as may be easier to use than other computer interfaces. In addition, these agent interfaces could overcome the passivity limitations of other methods and promote active learning and decision-making, provide patients with critical information independent of a provider, and permit the personalization of content regarding risks and benefits. The project team consists of a multidisciplinary team skilled the development of ECA, clinical research, and decision making among men with prostate cancer. For Aim 1 we will use a process of user-centered design with focus groups and iterative usability testing to develop a easy-to-use and well-accepted technology across literacy levels. For Aim 2 we will conduct a pilot clinical trial t test the hypothesis that the software can reduce decisional conflict among men with prostate cancer, a widely used outcome in the study of decision aids. Through this proposal we aim to meet the urgent need for patient-centered care for men with prostate cancer. Demonstration of clinical benefit will set the stage for future studies investigating the effect on important subgroups of patients such as those with limited health literacy and to study the integration of such a tool into clinical workflow. Ultimately we envision a tool that could be generalized to a number of other conditions and could transform the process of shared decision making for millions of patients.