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

项目摘要 共享决策（SDM）是临床医生和患者互动的主动过程，旨在 做出共同决定。对实施可持续发展机制和评估其对健康的影响至关重要 结果是有有效和可靠的工具来衡量可持续发展机制。虽然有几个工具 已经被设计来测量在临床遭遇中达成共同决定的过程，很少有 被认为是高质量的，没有一个是专门设计来衡量SDM的过程， 儿科.此外，大多数仪器从单一角度测量SDM过程（例如，患者 自我报告或观察者），尽管越来越多的认识到，临床医生的观点也需要准确地 捕获SDM的二元交互和固有的双向过程。 该项目的主要目标是开发和评估一种二元仪器来测量 SDM与幼儿的父母，包括父母和临床医生的观点。我们将锚 将该工具开发为我们开发的在儿科实施SDM的4步过程， 在初步工作中使用多个儿科患者的一组不同决策情景进行了验证 学科和不同的临床设置。这个过程的前三个步骤涉及医学上对[>1]的认识。 合理的选择（步骤1）;临床医生对选择的医疗受益-负担比的评估（步骤2）;以及 关于选项的偏好的父表达式（步骤3）。第4步鼓励父母或临床医生指导 基于步骤1-3的SDM，可以基于其他决策特征的存在进一步修改。 我们的具体目标是：（1）开发一种用于测量父母SDM过程的二元仪器 使用一个标准的，迭代的过程，包括项目的生成，项目的扩增， 通过专家评审减少项目，并与家长和临床医生进行预测试，其子目标是 开发该工具的一个双编码版本，以探索其与最终二元工具的相关性 （2）评估初步二元结构的内部一致性、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，其中[父母（N=600） 和临床医生（N=600）参与者]完成我们的初步二元工具后，随机查看 描述高质量和低质量SDM的4对不同的标准化视频插图之一 在儿科遇到一个独特的决定;（3）评估结构效度和可行性的， 在临床环境中，通过将仪器管理给父母和临床医生， 在[基于问题的遭遇（N=127）]之后，参与者在一系列儿科环境和专业中， 两个儿科机构，[子目标是开发最终的二元工具的西班牙语版本。 此R 01应用程序将产生一个有效和可靠的仪器，以可行地测量SDM的过程， 这将有助于对“可持续发展机制”在儿童健康方面的成果进行后续评估。

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.