Reducing Healthcare Disparities with Shared Decision Making

描述(由申请人提供)：患者和提供者之间的共同决策(SDM)与改善糖尿病控制、降低血压和其他积极的健康结果相关。然而，大多数SDM研究都是在资源充足的临床环境中的多数人群中进行的，因此对于哪些SDM的内容和过程最有可能改善资源不足的少数群体的结局存在重大空白。因此，这项建议的具体目标是：1.系统地审查关于种族和少数民族人口、儿童、老年人、代孕决策者、男男性行为者和变性人的典型条件或情况的共同决策的关键问题。A.探索关于信息共享、审议和决策的SDM领域的这些群体的已知情况。B.确定哪些工具改善了少数群体的可持续发展管理。C.探索在这些人群中影响SDM的背景因素的已知情况2.从代表少数民族人群和资源不足环境的不同利益相关者(包括组织、社区团体、医疗保健提供系统、临床医生和患者)那里获得关于期望的共享决策干预的输入和反馈。A.确定SDM所需的内容、信息表示和流程。B.为传统媒体、社交媒体、 和健康信息技术(HIT)。C.确定SDM产品开发和实施的优先事项。D.确定影响SDM的背景因素，如临床设计、激励措施和实施问题3.开发工具，帮助利益相关者在资源不足的少数群体中实施和评估SDM干预措施。研究团队将系统地审查文献，并在不同的利益相关者群体中进行访谈、焦点小组、关键利益相关者会议和社区论坛，以实现这些目标。该项目的工具将有助于在少数群体中创建一种有利于有效可持续发展管理的文化，促进为少数群体开发和修订现有可持续发展管理工具，并提供模板，以评估在资源不足的情况下可持续发展管理的干预措施。

DESCRIPTION (provided by applicant): Shared decision making (SDM) between patients and providers has been associated with improved diabetes control, lowered blood pressure, and other positive health outcomes. However, most SDM studies have been conducted in majority populations in well-resourced clinical settings, and thus a major void exists about what SDM content and processes are most likely to improve outcomes for minority populations in under-resourced settings. Thus, this proposal's specific aims are: 1. To systematically review key issues in shared decision making around paradigmatic conditions or situations for racial and ethnic minority populations, children, older persons, surrogate decision makers, men who have sex with men, and transgender individuals. a. To explore what is known about these groups regarding the SDM domains of information sharing, deliberation, and decision making. b. To identify what tools have improved SDM in minority populations. c. To explore what is known about contextual factors affecting SDM in these populations 2. To obtain the input and feedback from diverse stakeholders (including organizations, community groups, health care delivery systems, clinicians, and patients) representing minority populations and under- resourced settings around desired shared decision making interventions. a. To determine desired content, presentation of information, and process for SDM. b. To tailor to traditional media, social media, and health information technology (HIT). c. To determine priorities for development and implementation of SDM products. d. To determine contextual factors affecting SDM such as design of clinic, incentives, and implementation issues 3. To develop tools to help stakeholders implement and evaluate SDM interventions in minority populations in under-resourced settings. The study team will systematically review the literature and perform interviews, focus groups, key stakeholder meetings, and community forums across diverse stakeholder groups to accomplish these goals. The project's tools will help create a culture conducive to effective SDM in minority populations, facilitate development and revision of existing SDM tools for minority populations, and provide templates to evaluate SDM interventions in under-resourced settings.