Shared Decision-Making for Elderly Depressed Primary Care Patients

描述（由申请人提供）：与传统的医疗决策相比，共享决策（SDM）涉及一个协作过程，患者通过该过程表达个人价值观和偏好，临床医生提供信息以达成双方同意的治疗决策。SDM可能与抑郁症患者特别相关，因为它旨在以直接解决与抑郁症相关的无助和绝望的方式增强他们的自主性和权力。目前正在为初级保健中的抑郁症制定共同决策干预措施，但尚未进行充分的测试。也不知道关于共同决策加强自主和赋权能力的相同前提是否适用于老年人口。拟议的研究将评估三个会话SDM护理干预抑郁症老年初级保健患者的影响，在比较，以家庭护理（UC），对患者的依从性抗抑郁药物或心理治疗，并减少抑郁症状。SDM干预的重点是增强老年抑郁症初级保健患者的能力，帮助他们有效地做出可以成功实施的治疗决定。基于我们先前的工作，证明了患者的先验治疗偏好对治疗开始和依从性的影响，我们建议对老年抑郁症初级保健患者进行随机对照试验，以确定SDM对治疗依从性和减少抑郁症状的影响。该研究随机选取了30名来自布朗克斯的林肯医院（一家大型多元种族初级保健诊所）的医生，进行共同决策（SDM）或社区护理（UC）比较。根据医生随机化，总共210名抑郁症（PHQ-9>15）老年患者（其医生建议开始抑郁症治疗）将接受SDM或UC。将在基线和第4、8、12和24周对受试者进行评估，以确定治疗依从性和抑郁状态。如果SDM是有效的，它可以作为一个简短的独立的干预实践护士，并将提供一个平台，在各种初级保健实践环境和人群中定制和传播的模型。 公共卫生相关性：与传统的医疗决策相比，共同决策涉及一个协作过程，患者分享个人价值观和偏好，临床医生提供信息以达成相互同意的治疗决策。这项拟议的研究将评估抑郁症老年初级保健患者中共享决策护理干预对患者依从抑郁症治疗和改善抑郁症的影响。干预的重点是赋予老年抑郁症初级保健患者权力，帮助他们有效地做出他们可以成功实施的治疗决定。

DESCRIPTION (provided by applicant): Shared decision-making (SDM), in contrast to traditional medical decision-making, involves a collaborative process whereby patients articulate personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. SDM may be particularly relevant for depressed individuals, as it seeks to enhance their autonomy and empowerment in a manner that directly addresses the helplessness and hopelessness associated with depression. Shared decision-making interventions are being developed for depression in primary care, but have yet to be adequately tested. It is also unknown whether the same premises regarding shared decision-making's ability to enhance autonomy and empowerment pertain to elderly populations. The proposed study will evaluate the impact of a three-session SDM nursing intervention among depressed elderly primary care patients, in comparison to Usual Care (UC), on patient adherence to antidepressant medication or psychotherapy and on reduction in depressive symptoms. The focus of the SDM intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented. Based on our prior work that demonstrated the impact of patients' a priori treatment preferences on treatment initiation and adherence, we propose to conduct a randomized controlled trial of elderly depressed primary care patients to determine the impact of SDM on treatment adherence and reduction in depressive symptoms. The study randomizes 30 physicians from Lincoln Hospital in the Bronx, a large ethnically diverse primary care clinic, to either Shared Decision-Making (SDM) or the Usual Care (UC) comparison condition. A total of 210 depressed (PHQ-9>15) geriatric patients whose physicians' recommend starting depression treatment, will receive either SDM or UC according to physician randomization. Subjects will be assessed at baseline and at weeks 4, 8, 12, and 24 to determine treatment adherence and depressive status. If SDM is effective, it may serve as a brief independent intervention by practice nurses, and will provide a platform to tailor and disseminate the model throughout a variety of primary care practice settings and populations. PUBLIC HEALTH RELEVANCE: Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process whereby patients share personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. The proposed study will evaluate the impact of a shared decision- making nursing intervention among depressed elderly primary care patients on patient adherence to depression treatment and on improvement in depression. The focus of the intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that they can successfully implement.