Development and Evaluation of an Instrument to Measure Shared Decision-Making in Pediatrics

项目总结 共享决策(SDM)是临床医生和患者互动的主动过程，旨在 共同做出决定。对实施可持续发展管理及其对健康影响的评估至关重要 结果是有有效和可靠的工具来衡量可持续发展指标。虽然有几种乐器 已经被设计用来衡量在临床会面中达成共同决定的过程，很少有人这样做 被认为是高质量的，没有一个是专门设计来衡量SDM过程的 儿科。此外，大多数仪器从单一角度(例如，患者)测量SDM过程 自我报告或观察者)，尽管越来越认识到临床医生的观点也需要准确地 捕捉SDM的二元相互作用和固有的双向过程。 这个项目的主要目标是开发和评估一种二元仪器来测量 与年幼儿童的父母进行的SDM，包括父母和临床医生的观点。我们将锚定 将此仪器开发为我们开发的在儿科实施SDM的四步流程，并 在初步工作中使用多个儿科医生的不同决策方案进行验证 学科和不同的临床环境。此过程的前3个步骤涉及医学上对[&gt；1]的识别 合理的备选方案(步骤1)；临床医生对备选方案的医疗效益-负担比率的评估(步骤2)；以及 有关选项的首选项的父级表达(步骤3)。步骤4鼓励家长或临床医生指导 基于步骤1-3的SDM，可以根据其他决策特征的存在进行进一步修改。 我们的具体目标是(1)开发一个与父母一起测量SDM过程的二元工具 使用标准的迭代过程，包括项目的生成、项目的扩充 池，通过专家审查减少项目，以及与父母和临床医生进行预测试，子目标是 开发仪器的观察者编码版本，以探索其与最终二元仪器的相关性 在目标3；(2)评估初步二元测验的[内部一致性]、结构效度和信度 通过进行在线实验在受控的模拟环境中使用仪器[Parent(N=600)] 和临床医生(N=600)参与者]在随机查看后完成我们的初步二元工具 描述高质量和低质量SDM的4对不同的标准化视频片段之一 在儿科遇到一个独特的决定；和(3)评估结构的有效性和可行性 临床环境中的最终二元仪器，通过给父母和临床医生使用该仪器 参与者在[基于问题的接触(N=127)]之后，涉及一系列儿科环境和专科，网址为 两个儿科机构，[次级目标是开发最终二元仪器的西班牙语版本。] 此R01应用程序将产生一个有效和可靠的工具，用于可行地测量SDM过程 这将有助于对儿童健康状况进行后续评估。

PROJECT SUMMARY Shared decision-making (SDM) is an active process of clinician and patient interaction that is intended to produce a joint decision. Critical to the implementation of SDM and the evaluation of its effect on health outcomes is the availability of valid and reliable instruments to measure SDM. Though several instruments have been designed to measure the process of arriving at a shared decision in the clinical encounter, few have been deemed high quality and none have been specifically designed to measure the process of SDM in pediatrics. Furthermore, most instruments measure the SDM process from a singular perspective (e.g., patient self-report or observer) despite increasing recognition that clinician perspectives are also needed to accurately capture the dyadic interaction and inherently bidirectional process of SDM. The primary goal of this project is to develop and evaluate a dyadic instrument to measure the process of SDM with parents of young children that includes both parent and clinician perspectives. We will anchor the development of this instrument to a 4-step process for implementing SDM in pediatrics that we developed and validated in preliminary work using a diverse set of decision-making scenarios across multiple pediatric disciplines and varied clinical settings. The first 3 steps of this process involve recognition of [>1] medically reasonable option (Step 1); clinician assessment of the medical benefit-burden ratios of options (Step 2); and parent expression of preferences regarding options (Step 3). Step 4 encourages a parent- or clinician-guided SDM based on Steps 1-3 that can be further modified based on the presence of other decisional features. Our specific aims are to (1) develop a dyadic instrument for measuring the SDM process with parents of young children using a standard, iterative process that includes item generation, augmentation of the item pool, item reduction through expert review, and pretesting with parents and clinicians, with a sub-aim to develop an observer-coded version of the instrument to explore its correlation with the final dyadic instrument in Aim 3; (2) assess the [internal consistency], construct validity and reliability of the preliminary dyadic instrument in a controlled, simulated setting by conducting an online experiment in which [parent (N=600) and clinician (N=600) participants] complete our preliminary dyadic instrument after being randomized to view one of 4 different pairs of standardized video vignettes that portray a high-quality and low-quality SDM encounter of a unique decision in pediatrics; and (3) evaluate the construct validity and feasibility of the final dyadic instrument in the clinical setting by administering the instrument to parent and clinician participants after [problem-based encounters (N=127)] across a range of pediatric settings and specialties at two pediatric institutions, [with a sub-aim to develop a Spanish version of the final dyadic instrument.] This R01 application will yield a valid and reliable instrument to feasibly measure the process of SDM with parents of young children and will enable follow-on evaluation of SDM on child health outcomes.