Using a Mixed Methods Approach to Understand Shared Decision-Making in Lung Cancer Screening

项目摘要/摘要 加强以患者为中心的护理的努力导致了对共同决策的更多倡导 (SDM)。然而，SDM中积极影响决策质量和患者结局的有效成分仍然存在 难以捉摸。肺癌筛查的讨论和决定对患者和临床医生来说都是具有挑战性的， 好处是存在的，但风险和不确定性也存在，而且因人而异。迫切需要确定 患者和临床医生在肺癌筛查中如何接近SDM及其对决策质量的影响 以及重要的行为后果。在没有这些知识的情况下，有效的干预措施既支持患者 临床医生是不能培养的。我们的长期目标是开发下一代决策支持工具 和其他沟通策略，以支持临床医生和患者面对日益复杂的问题 癌症筛查决定。我们在此应用程序的总体目标是确定患者的组件- 临床医生的讨论有助于高质量的肺癌筛查决定和随后的重要 行为结果。我们的中心假设是，认为肺癌筛查的患者讨论 与他们的临床医生共享将会有积极的决策和行为结果。以强劲的前期工作为指导 数据，这一假设将通过追求三个具体目标来检验：1)确定SDM的关键组成部分 预测患者感知的肺癌筛查决策质量、筛查完成率的过程 决定进行筛查的患者，以及当前吸烟者戒烟准备的阶段；2)确定 预测患者的临床医生因素--肺癌筛查决策质量、筛查完成率 决定进行筛查的患者中，以及当前吸烟者戒烟准备的阶段；以及 3)确定预测患者的患者因素--感知的肺癌筛查决策质量、筛查 决定进行筛查的患者的完成情况，以及目前准备戒烟的阶段 吸烟者。我们将使用融合的混合方法设计来检查临床医生(N=75)和患者(N=550)。 通过将患者和临床医生的调查数据与电子健康记录数据相关联，可同时影响多个因素。我们会 通过对#年预防性护理访问录音的内容分析，进一步审查决策过程。 讨论了哪种肺癌筛查(N=30)。这项提议是创新的，因为结果将呈指数级增长 提高我们创建下一代决策支持工具的能力，包括替代通信 战略，支持患者和临床医生进行肺癌筛查。这一贡献意义重大，因为 确定SDM过程中的“有效成分”将开辟新的研究视野，特别是在健康方面 临床医生和患者之间的沟通，他们正在导航复杂的与健康相关的决策，例如 肺癌筛查。由于这项工作，我们还将开辟改善健康的新途径 在高危、长期吸烟者和他们的临床医生之间就他们的健康进行沟通。

PROJECT SUMMARY/ABSTRACT Efforts to enhance patient-centered care have resulted in increasing advocacy for shared decision-making (SDM). Yet, the active ingredients of SDM that positively impact decision quality and patient outcomes remain elusive. Lung cancer screening discussions and decisions are challenging for both patients and clinicians where benefits are present, but risk and uncertainty exist and vary by individual. There is a critical need to determine how patients and clinicians are approaching SDM in lung cancer screening and the impact on decision quality and important behavioral outcomes. Without this knowledge, effective interventions that support both the patient and clinician cannot be developed. Our long term goal is to develop the next generation of decision support tools and alternative communication strategies to support clinicians and patients as they face increasingly complex cancer screening decisions. Our overall objective in this application is to identify the components of patient- clinician discussions that contribute to high quality lung cancer screening decisions and subsequent important behavioral outcomes. Our central hypothesis is that patients who perceive lung cancer screening discussions with their clinician as shared will have positive decisional and behavioral outcomes. Guided by strong preliminary data, this hypothesis will be tested by pursuing three specific aims: 1) determine the key components of the SDM process that predict patient-perceived lung cancer screening decision quality, screening completion among patients who decide to screen, and stage of readiness for smoking cessation among current smokers; 2) identify clinician factors that predict patient-perceived lung cancer screening decision quality, screening completion among patients deciding to screen, and stage of readiness for smoking cessation among current smokers; and 3) identify patient factors that predict patient-perceived lung cancer screening decision quality, screening completion among patients deciding to screen, and stage of readiness for smoking cessation among current smokers. We will use a convergent mixed methods design to examine clinician (N=75) and patient (N=550) factors simultaneously by linking patient and clinician survey data with electronic health record data. We will examine further the decision process through content analysis of audio-recordings of preventive care visits in which lung cancer screening is discussed (N=30). This proposal is innovative in that results will exponentially advance our ability to create the next generation of decision support tools, including alternative communication strategies, to support patients and clinicians in lung cancer screening. This contribution is significant because identifying the “active ingredients” in the SDM process will open new research horizons, particularly in health communication, between clinicians and patients who are navigating complex health-related decisions such as lung cancer screening. Because of this work, we will also open new paths toward improving health communication among high-risk, long-term smokers and their clinicians about their health.