Validation of a Framework for Shared Decision-Making in Pediatrics

项目摘要 共同决策（SDM）的主要目标是确保医疗决策纳入 受医疗决策影响的患者的偏好。SDM和支持其使用的工具已经 发现可以提高患者对结果，风险以及他们选择与他们的选择相匹配的选项的了解。 价值观因此，SDM已经成为医学中的标准决策模型。但其 儿科领域的实施受到了对SDM如何实现的不完全理解的阻碍， 应该会在儿科常见的决策场景中表现出来。[For例如， 儿科必须适应多个目标，如保护儿童，尊重新生儿的自主权， 尊重父母的价值观和决策权，这使它有别于 对成年人实施SDM，其唯一目标是保护或促进患者自主性]。有 没有在儿科实施SDM的模型，全面解决这些问题和其他问题， 儿科决策的共同特征。 这个项目的主要目标是根据经验完善一个在儿科实施SDM的框架 使用跨多个儿科学科[和儿童年龄]的一组不同的决策场景。这 框架包括四个步骤。前3个步骤向临床医生提出了一个问题，答案将指导临床医生进行治疗。 临床医生进一步沿着框架（步骤1（医疗合理性）：决策是否包括超过 一个医学上合理的选择？第2步（受益-负担）：一种选择是否具有有利的医疗受益- 与其他选择相比，负担率如何？步骤3（偏好敏感性）： 选项？）。步骤4（校准）就具体的可持续发展机制方法提供了指导， 根据步骤1-3的答案以及其他决策特征进行考虑。 我们的具体目标是（1）评估儿科SDM框架在一个范围内的适用性， 通过（a）对以问题为导向的医疗遭遇进行录像（N=[30]） 涉及6个儿科临床服务（颅面、泌尿科、肺科， 血液学/肿瘤学、儿科重症监护和普通儿科/医院医学），（B）进行[75] 与临床医生（N=30）、父母（N=30）[和11-17岁儿童（N=15）]参与者进行就诊后访谈 使用视频刺激回忆来确定可持续发展机制框架中的差距，以及（c）修订框架 相应地;（2）通过以下方式评估修订后的儿科SDM框架的表面和内容有效性： 举办4个焦点小组，征求对订正框架内容和组成部分的意见。 此R 03应用程序将为在儿科实施SDM的有效过程提供证据。的 这项建议的结果将为未来的R 01资助的研究提供信息，以开发、评估和前瞻性地测试一种工具 来测量儿科的SDM

PROJECT SUMMARY A primary objective of shared decision-making (SDM) is to ensure medical decision-making incorporates the preferences of the patients affected by the medical decision. SDM and tools that support its use have been found to improve patients' knowledge of outcomes, risks, and their selection of an option that matches their values. Consequently, SDM has emerged as the standard decision-making model in medicine. However, its implementation in the field of pediatrics has been hampered by an incomplete understanding of how SDM should manifest in decision-making scenarios common to pediatrics. [For instance, implementation of SDM in pediatrics must accommodate multiple goals, such as protecting the child, honoring the emerging autonomy of adolescents, and respecting parental values and decision-making authority, which distinguishes it from the implementation of SDM with adults where the singular goal is to protect or promote patient autonomy]. There is no model for the implementation of SDM in pediatrics that comprehensively addresses these and other features common to pediatric decision-making. The primary goal of this project is to empirically refine a framework for implementing SDM in pediatrics using a diverse set of decision-making scenarios across multiple pediatric disciplines [and child ages]. This framework includes 4 steps. The first 3 steps pose a question to the clinician, with the answers directing the clinician further along the framework (Step 1 (Medical Reasonableness): does the decision include more than one medically reasonable option?; Step 2 (Benefit-Burden): does one option have a favorable medical benefit- burden ratio compared to other options?; Step 3 (Preference Sensitivity): how preference-sensitive are the options?). Step 4 (Calibration) provides direction on the specific SDM approach to use for the decision under consideration based on the answers to Steps 1-3 as well as other decisional characteristics present. Our specific aims are to (1) to assess the applicability of the pediatric SDM framework across a range of medical decisions [and child ages] by (a) videotaping problem-oriented medical encounters (N=[30]) involving children [≤17] years old in 6 pediatric clinical services (craniofacial, neonatology, pulmonary, hematology/oncology, pediatric intensive care, and general pediatrics/hospital medicine), (b) conducting [75] post-encounter interviews with clinician (N=30), parent (N=30) [and 11-17 year old child (N=15)] participants using video-stimulated recall to identify gaps in the SDM framework, and (c) revising the framework accordingly; (2) to assess the face and content validity of the revised pediatric SDM framework by conducting 4 focus groups to elicit input on the content and components of the revised framework. This R03 application will provide evidence for a valid process for implementing SDM in pediatrics. The results of this proposal will inform a future R01-funded study to develop, evaluate, and prospectively test a tool to measure SDM in pediatrics.