Adapting & Evaluating Measures of Decision Quality for Common Medical Decisions

项目总结/摘要 2004年，调查人员开始研究“决策质量”的衡量标准， “决策过程”，重点放在三个要素-在何种程度上，病人（1） 了解选项及其利弊，（2）有意义地参与决策- （3）接受反映其目标的治疗。从那时起，调查人员 已经产生了14个决策特定的决策质量工具和一个通用的共享 决策过程调查，以评估这三个要素。他们最近收到了 国家质量论坛认可基于这些的两项绩效指标 针对特定择期手术决策的调查。 调查人员在不同的国家积累了大量关于SDM进程调查的数据， 不同的病人，使用不同的给药方式。但 尚未对现有数据进行任何系统的检查，以确定 单词项以及这些项是否或如何基于临床决策的方面而变化。 此外，该调查主要用于40岁及以上的成年人，主要关注 选择性手术的决定因此，在推广方面还有许多工作要做 可持续发展机制进程调查的普遍性。 在本提案中，调查人员将对SDM流程进行重大改进 调查，并将扩大其普遍性。我们将对现有数据进行二次分析 从13，000多名受访者中，比较了不同临床主题的性能（目标1）， 我们将对2,000名受访者进行有针对性的在线实地测试， 措辞项目的方法，并将其推广到年轻人和父母 为他们的孩子做决定（目标2），我们将在临床环境中进行实地测试， 有决策支持程序，以建立有效性和可行性（目标3）。的 适应性措施具有较强的心理测量性和可操作性 特性.该措施和相关的用户指南将为研究人员和临床医生提供一个 评估共享决策并比较不同决策支持的清晰方法 旨在提高医疗决策质量的战略。

Project Summary/Abstract In 2004, the investigators started working to develop measures of “decision quality” and “decision making process” that focus on three elements—the extent to which the patient (1) understands the options and their pros and cons, (2) is meaningfully involved the decision- making process and (3) receives treatment that reflects their goals. Since then, the investigators have produced fourteen decision-specific Decision Quality Instruments and a generic Shared Decision Making (SDM) Process survey to assess these three elements. They recently received endorsement by the National Quality Forum for two performance measures based on these surveys for specific elective surgical decisions. The investigators have amassed a large amount of data on the SDM Process survey in different medical contexts, with different patients, using different modes of administration. However, there has not yet been any systematic examination of existing data to determine the best ways to word items and whether or how the items should vary based on aspects of the clinical decision. Further, the survey has been predominantly used in adults 40 and older, with a major focus on elective surgery decisions. As a result, there is still much work to be done to extend generalizability of the SDM Process survey. In this proposal, the investigators will make significant improvements to the SDM Process survey and will extend its generalizability. We will conduct secondary analyses of existing data from more than 13,000 respondents and compare performance across clinical topics (Aim 1), we will conduct targeted online field tests with 2,000 respondents to evaluate alternative approaches to wording items and to extend generalizability to younger adults and parents making decisions for their children (Aim 2), and we will conduct field tests in clinical settings that have decision support programs in order to establish validity and feasibility (Aim 3). The adapted measure will be practical and feasible to implement, with strong psychometric properties. The measure and associated user guides will provide researchers and clinicians a clear means to evaluate shared decision making and compare different decision support strategies designed to improve the quality of medical decisions.