SDMo – a measure of the occurrence of SDM in the care of patients with chronic conditions

项目摘要/摘要 共享决策（SDM）是患者和临床医生共同努力了解 病人的问题情况，并协同制定一个护理计划，使智力，实用， 作为对情境和个人个性的反应的情感感觉。SDM的实践是广泛的 通过临床指南、组织和政府政策和倡议促进， 以病人为中心的护理。SDM的一个目标是通过提高健康和行为结果， 患者参与决策，但事实证明很难确定这种影响，部分原因是 测量SDM的局限性。研究人员目前还没有他们需要的措施来确定，在任何 在患者-临床医生相遇时，SDM过程用于协作地商议并形成护理计划。的 由于缺乏概念上和操作上的清晰度，确定SDM发生的能力受到很大的限制， 可持续发展机制、狭窄的衡量框架以及对现有观察员和自我报告措施的限制， 特别是在慢性多发性硬化症的情况下。因此，在这项为期三年的研究中， SDM，测量开发和验证以及以用户为中心的设计方面的专家建议开发一个 基于理论的、专家告知的、用户测试的、基于所有者的SDM发生率测量（“SDMo”）， 估计其信度和效度。具体而言，本申请的目标是开发一个全面的 一组项目，使用现有的文献和理论来捕捉可观察到的过程和行为， SDM（目标1）：使用目标1中的候选项目，部署以用户为中心的设计过程， 通过现场测试和改进的迭代过程， 在先前收集的视频记录的临床就诊语料库上测量SDMo（目标2）;以及 估计SDMo测量的信度和效度（目标3）。实现这三个目标将导致 在慢性多发性骨髓瘤患者的临床遭遇中SDM发生率的可用测量， 该措施的可靠性和有效性，以及用户测试的用户手册，其中将包括详细的解释， 每个项目，其使用说明，并与视频剪辑，将促进高度可靠的使用培训程序 其他研究人员的仪器。从长远来看，新措施SDMo将有助于揭示 SDM在多种慢性疾病患者护理中的真实的普及并提高质量 在这一重点人群中开展关于可持续发展机制的研究的一致性。最终，一个全面的，有效的，可靠的 SDM的测量将允许临床研究人员严格测试SDM实践与 行为和身体健康结果，并促进基于新证据的临床实践的改进。

PROJECT SUMMARY/ABSTRACT Shared decision making (SDM) is a process in which patients and clinicians work together to understand the patient’s problematic situation and collaboratively develop a plan of care that makes intellectual, practical, and emotional sense as a response to the situation and the individuality of the person. The practice of SDM is widely promoted through clinical guidelines, organizational and governmental policies and initiatives, and is a feature of patient-centered care. A goal of SDM is to improve health and behavioral outcomes through enhancing patients’ participation in decision making, however it has proven hard to establish this impact, in part due to limitations in measuring SDM. Researchers currently do not have the measures they need to determine if, in any patient-clinician encounter, a SDM process was used to collaboratively deliberate and form a plan of care. The ability to determine the occurrence of SDM is highly limited by a lack of conceptual and operational clarity around SDM, narrow measurement frameworks, and limitations to existing observer and self-reported measures, particularly in the context of chronic multimorbidity. Therefore, in this three-year study, the team—comprising experts in SDM, measure development and validation, and user-centered design—propose to develop a theoretically based, expert-informed, user-tested, observer-based measure of SDM occurrence (“SDMo”) and to estimate its reliability and validity. Specifically, the objectives of this application are to develop a comprehensive set of items using existing literature and theory to capture observable processes and behaviors indicative of SDM (Aim 1); using candidate items derived from Aim 1, to deploy a user-centered design process to develop a usable and feasible measure of SDM occurrence through an iterative process of field testing and refinement of the SDMo measure on a previously collected corpus of video-recorded clinical encounters (Aim 2); and to estimate the reliability and validity of the SDMo measure (Aim 3). Completion of these three aims will result in a usable measure of SDM occurrence in clinical encounters with patients with chronic multimorbidity, estimates of the measure’s reliability and validity, and a user-tested Users’ Manual that will include a detailed explanation of each item, illustrations for its use, and a training procedure with video clips that will promote highly reliable use of the instrument by other researchers. In the long-term, the new measure, SDMo, will contribute to uncovering the real prevalence of SDM in the care of patients with multiple chronic health conditions and improve the quality and consistency of research on SDM in this priority population. Ultimately, a comprehensive, valid, and reliable measure of SDM will allow clinical researchers to rigorously test associations between the practice of SDM and behavioral and physical health outcomes and facilitate improvements to clinical practice based on new evidence.