Developing a Standardized Process Assessment for Relationship-Centered Shared Decision-Making (SPARCSdm)

项目摘要 该项目的目标是开发一种能够捕获共享决策过程的评估 (SDM)适用于那些因为缺乏认知能力而无法为自己辩护的人 为自己做出决定，并有能力传达自己的意愿。当前的SDM评估不是 为这些人设计的，通常侧重于遭遇结果，而不是通过 这就是SDM展现的。为了解决这一知识差距，一个由多学科研究人员组成的团队，医疗保健 利益相关者和关怀合作伙伴将协作设计和测试观察者评级的标准化流程 评估以关系为中心的共享决策(SPARCSdm)，由我们的 以关系为中心的SDM流程模型。在目标1中，我们将观察、访谈和分析患者- 医生-护理伙伴三合会在做出决定的地方相遇。这些观察将被用来 定义可修改的协作和信息交换技能，确定项目和评级标准 SPARCSdm，并设计了包括管理程序的原型评估。在目标2中，评审员 将使用专门为该项目开发的基于能力的在线培训进行培训；一次 经过培训后，他们将观察录制下来的SDM相遇，并分别为护理合作伙伴和从业者评分 在SPARCSdm上。这些数据使用多面Rasch模型(MFRM)进行分析以进行调整 评估员的严重程度/宽大程度和遇到的复杂性，将提供SPARCSdm的初步证据 心理测量学，促进评估的概念和结构有效性的评估，并告知 精细化的在线培训。在目标3中，我们将把知识应用到行动实施中 通过确定支持和障碍、可用性、 和可接受性。该项目推进了对慢性残疾人及其护理伙伴的护理。 通过开发以关系为中心、包含多个视角的流程评估，以及 用户界面友好。因此，它高度响应了AHRQ对开发SDM的项目的请求 流程评估，由概念模型提供信息，以获取优先级的多个视角 需要长期护理的残疾人等人群。此评估是必要的，因为 临床监督员和医学教育工作者目前正在努力确定SDM发生的时间和 哪些从业者和护理伙伴需要具备SDM技能的支持。注重易用性和集成性 在整个设计过程中的支持和实施障碍确保该项目将 有效地为更大规模的SPARCSdm测试以及更长期的测量 旨在改善SDM的干预计划的有效性。

Project Summary This project's goal is to develop an assessment that captures the process of shared decision-making (SDM) for persons who cannot advocate for themselves because they lack the cognitive capacity to decide for themselves and the ability to communicate their wishes. Current SDM assessments are not designed for these individuals and generally focus on encounter outcomes rather than the process by which SDM unfolds. To address this knowledge gap, a team of multi-disciplinary researchers, healthcare stakeholders, and care partners will collaborate to design and test the observer-rated Standardized Process Assessment of Relationship-Centered Shared Decision-Making (SPARCSdm), informed by our relationship-centered SDM process model. In Aim 1, we will observe, interview and analyze patient- practitioner-care partner triad encounters where decisions are made. These observations will be used to define modifiable collaboration and information exchange skills, identify items and rating scales for the SPARCSdm, and design a prototype assessment including administration procedures. In Aim 2, assessors will be trained using an online, competency-based training developed specifically for this project; once trained, they will observe videotaped SDM encounters and separately score care partners and practitioner on the SPARCSdm. These data, analyzed using the many facets Rasch model (MFRM) to adjust for assessor severity/leniency and encounter complexity, will provide preliminary evidence of SPARCSdm psychometrics, facilitate appraisal of the assessment's conceptual and structural validity, and inform refinements of the online training. In Aim 3, we will apply the Knowledge to Action implementation science strategy to scale up the prototype for future testing by identifying supports and barriers, usability, and acceptability. This project advances care for persons with chronic disabilities and their care partners by developing a process assessment that is relationship-centric, inclusive of multiple perspectives, and user-friendly. As such, it is highly responsive to AHRQ's request for projects that develop an SDM process assessment, informed by a conceptual model, to capture multiple perspectives for priority populations such as persons with disabilities who need chronic care. This assessment is needed because clinical supervisors and medical educators currently struggle to identify when SDM has taken place and which practitioners and care partners need support with SDM skills. Attention to usability and integration of supports and barriers to implementation throughout the design process ensures this project will effectively set the stage for larger scale testing of the SPARCSdm, and longer-term, for measuring the effectiveness of intervention programs aimed at improving SDM.