Improving urinary and sexual dysfunction after prostate surgery using shared decision making

项目摘要 共同决策（SDM）是临床医生和患者之间的协调努力，以选择平衡的护理计划 患者的偏好和价值观。共同决策已被确定为高- 质量保健服务，并已被提议作为医生报销的质量指标。但 卫生保健提供者和政策制定者对SDM的支持与SDM的实施之间存在脱节， 实践此外，缺乏评估SDM的措施，这可能阻碍其临床应用。 尽管如此，SDM已在国家政策层面和指导方针范围内得到授权和推荐 报表鉴于此，提供SDM在泌尿外科中的实际使用数据并制定有意义的措施， SDM是必要的。导致泌尿科医生使用决策辅助工具和共同决策的因素主要是 目前尚不清楚，很少有人研究SDM与泌尿系统结局指标之间的关系， 临床医生和患者。 使用一个大型的、前瞻性收集的、全州范围的患者报告结局（PRO）数据库， 对于在前列腺手术前使用过决策辅助的患者，我们将评估促进决策的实践和患者水平因素。 决策辅助工具的使用，并评估决策辅助工具和患者报告的泌尿系统结果之间的联系。我们假设 实践因素和患者属性都将影响使用决策辅助的可能性。我们还预测， 那些在接受前列腺手术之前使用决策辅助的患者将改善患者报告的结果 测量，如在经验证的仪器上通过尿失禁和勃起功能障碍困扰评分测量的。 该提案将是第一个分析基于社区的大型共享决策倡议的结果的提案。 此外，它将填补共享决策的使用和患者报告之间的关键知识差距。 结果测量。在以病人为中心的护理时代，这些发现将有助于为实施共享医疗服务的努力提供信息。 泌尿外科实践中的决策。

PROJECT SUMMARY Shared decision making (SDM) is a concerted effort between clinicians and patients to select care plans that balance evidence with patient preferences and values. Shared decision making has been identified as a key component of high- quality health care delivery and has been proposed as a quality metric for physician reimbursement. However, a disconnect exists between support of SDM by healthcare providers and policymakers, and the implementation of SDM in practice. Furthermore, there is a lack of measures to assess SDM, which may be impeding its clinical use. Despite this, SDM has been mandated and recommended at a policy level both nationally and within guideline statements. In light of this, providing data about real-world use of SDM in urology and developing meaningful measures of SDM is imperative. The factors that lead to use of decision aids and shared decision making by urologists are largely unknown and few have studied the association between SDM and urologic outcome measures that are salient to clinicians and patients. Using a large, prospectively collected, state-wide database of patient reported outcomes (PRO) linked among patients who have used a decision aid prior to prostate surgery, we will assess the practice and patient level factors that facilitate decision aid use and evaluate the link between decision aids and patient reported urologic outcomes. We hypothesize that both practice factors and patient attributes will influence the likelihood of using a decision aid. We also predict that those who use a decision aid prior to undergoing prostate surgery will have improved patient reported outcome measures, as measured by urinary incontinence and erectile dysfunction bother scores on validated instruments. This proposal will be the first to analyze the results of a large, community based, shared decision making initiative. Furthermore, it will fill a critical knowledge gap in the link between use of shared decision making and patient reported outcome measures. In the era of patient centered care, these findings will help inform efforts to implement shared decision making in urologic practice.