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

描述(由申请人提供)：虽然患者偏好对选择最佳治疗至关重要，但研究发现患者偏好和接受的治疗之间存在差异。这些缺陷威胁着患者的自主权，危及患者的安全，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接受的护理。在SDM中，患者和提供者结成伙伴关系，根据最佳可用证据做出决定，这些证据是根据患者的价值观、偏好和医疗保健目标加权的。然而，SDM没有得到充分利用，现有的促进它的工具(称为决策辅助工具)不足以忽视数百万美国人的需求，包括那些健康素养有限的人。具体化对话代理(ECA)是模拟面对面对话的计算机动画角色，可用于促进SDM。这些工具可能对健康素养有限的患者特别有用，因为它们可能比其他计算机界面更容易使用。此外，这些代理界面可以克服其他方法的被动局限性，促进主动学习和决策，向患者提供独立于提供者的关键信息，并允许个性化有关风险和收益的内容。该项目团队由一个多学科团队组成，精通ECA的开发、临床研究和前列腺癌男性患者的决策。对于目标1，我们将使用以用户为中心的设计过程，通过焦点小组和迭代可用性测试来开发一种易于使用和被广泛接受的跨识字水平的技术。对于目标2，我们将进行一项试点临床试验，测试该软件可以减少前列腺癌男性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。通过这项提议，我们的目标是满足前列腺癌男性患者以患者为中心的迫切需要。临床益处的展示将为未来的研究奠定基础，这些研究将调查这种工具对重要患者亚群的影响，例如那些健康素养有限的人，并研究将这种工具整合到临床工作流程中。最终，我们设想了一种可以推广到许多其他情况的工具，并可以改变数百万患者的共享决策过程。

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.