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

项目概要/摘要 加强以病人为中心的护理的努力导致越来越多的倡导共同决策 （SDM）。然而，积极影响决策质量和患者结果的SDM的活性成分仍然存在 难以捉摸肺癌筛查的讨论和决策对患者和临床医生都具有挑战性， 好处是存在的，但风险和不确定性也存在，而且因人而异。现在迫切需要确定 患者和临床医生如何在肺癌筛查中采用SDM以及对决策质量的影响 和重要的行为结果。如果没有这些知识，有效的干预措施，支持病人 也不能培养临床医生。我们的长期目标是开发下一代决策支持工具 和替代的沟通策略，以支持临床医生和患者，因为他们面临越来越复杂的 癌症筛查决策。我们在此应用中的总体目标是识别患者的组成部分- 有助于高质量肺癌筛查决策的临床医生讨论以及随后的重要 行为结果我们的中心假设是，认为肺癌筛查讨论 与他们的临床医生共享将有积极的决策和行为结果。以强有力的初步指导 数据，这一假设将通过追求三个具体目标进行测试：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、 决定进行筛查的患者，以及当前吸烟者戒烟的准备阶段; 2）确定 预测患者感知的肺癌筛查决策质量、筛查完成的临床医生因素 决定进行筛查的患者，以及当前吸烟者的戒烟准备阶段;以及 3)识别预测患者感知的肺癌筛查决策质量的患者因素，筛查 决定进行筛查的患者的完成情况，以及目前 吸烟者。我们将使用收敛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调查数据与电子健康记录数据相关联，同时考虑各种因素。我们将 通过对预防保健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）。这一提议的创新之处在于， 提高我们创建下一代决策支持工具的能力，包括替代通信 策略，以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 在SDM过程中确定“活性成分”将开辟新的研究领域，特别是在健康领域 沟通，临床医生和患者之间的导航复杂的健康相关的决定， 肺癌筛查由于这项工作，我们还将开辟改善健康的新途径 高风险，长期吸烟者和他们的临床医生之间关于他们的健康的沟通。

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.