A Novel Patient-centered Decision Aid to Inform Alcohol Treatment Choices

描述(申请人提供)：摘要。背景：共享决策是现代以患者为中心的医疗服务的基础。理想情况下，在共同的决策制定中，临床医生提供关于治疗方案的信息，患者澄清他们的担忧和可能影响他们选择的偏好。然而，临床医生往往缺乏所需的信息和时间来探索每种治疗方案对患者的利弊。患者决策辅助工具有助于解决这一问题，并已演变为支持医疗环境中共享决策的关键工具。因此，现在已经有了关于如何开发决策辅助工具的国际标准，并且有了高质量的决策辅助工具的在线存储库。然而，据我们所知，尽管有多种循证治疗，但没有为酒精使用障碍(AUD)患者提供决策辅助。目标：拟议的为期18个月的严格研究将开发出符合国际标准的高质量AUD患者决策辅助工具。具体目标是：1)了解患者、家庭成员和临床医生对AUD共同决策的需求；2)系统地审查关于AUD治疗方案的有效性和风险的现有证据；以及3)开发和进行与AUD患者共同决策的决策辅助的初步现场测试。方法：本研究将在一个大型地区性卫生保健系统中进行。我们将对AUD患者进行半结构化访谈，并与AUD患者家属和临床医生进行焦点小组访谈，以了解用户需求(目标1)。我们将系统地回顾目前高质量临床实践指南(目标2)推荐的9种循证治疗的益处和风险的文献：5种行为疗法(认知行为疗法、动机增强疗法、行为伴侣疗法、12步促进疗法和社区强化)；以及4种药物(纳曲酮、氨基己酸酯、双硫仑、托吡酯)。将根据AIMS 1-2的调查结果，在跨学科指导委员会(AIMS 3)的指导下，开发患者决策辅助工具。决策辅助工具的清晰度和可接受性将通过与用户的认知访谈(阿尔法测试)进行评估。将对20名AUD患者和护理他们的临床医生进行决策辅助工具可用性的初步现场测试(Beta测试)，以评估其对共同决策的影响。对公共健康的影响：这项研究将开发一种创新的工具，让AUD患者参与治疗。此外，这一研究路线有可能改变卫生保健环境中AUD的管理，超越目前非个性化的“转诊到治疗”方法，转向基于共享决策的以患者为中心的方法。这样的转变可以将以患者为中心的护理带到医疗环境中的AUD管理中。

DESCRIPTION (provided by applicant): SUMMARY. BACKGROUND: Shared decision making is the foundation of modern patient-centered medical care. Ideally, in shared decision making, clinicians offer information on treatment options, and patients clarify their concerns and preferences that might affect their choices. However, clinicians often lack the required information and the time to explore all the pros and cons of each therapeutic option with patients. Patient decision aids help solve this problem, and have evolved into critical tools for supporting shared decision making in medical settings. As a result, international standards now exist for how decision aids should be developed, and there are online repositories of high quality decision aids. However, to our knowledge, no decision aid exists for patients with alcohol use disorders (AUD) despite the availability of multiple evidence- based treatments. OBJECTIVES: The proposed rigorous 18-month study will develop a high quality patient decision aid for AUD consistent with international standards. Specific aims are: 1) to understand the needs of patients, family members, and clinicians regarding shared decision making for AUD; 2) to systematically review the available evidence on the efficacy and risks of AUD treatment options that should be offered to adult patients; and 3) to develop and conduct initial field tests of a decision aid for shared decision making with patients with AUD. METHODS: This study will be conducted in a large regional health care system. We will use semi-structured interviews with patients with AUD, and focus groups with family members of patients with AUD and clinicians, to understand user needs (Aim 1). We will systematically review the literature on the benefits and risks of 9 evidence-based treatments currently recommended by high-quality clinical practice guidelines (Aim 2): 5 behavioral treatments (cognitive behavioral therapy, motivational enhancement therapy, behavioral couples therapy, 12-step facilitation, and community reinforcement); and 4 medications (naltrexone, acamprosate, disulfiram, topiramate). A patient decision aid will be developed based on Aims 1-2 findings, guided by an interdisciplinary Steering Committee (Aim 3). The clarity and acceptability of the decision aid will be assessed using cognitive interviews with users (alpha testing). Initial field tests of the usability of the decision aid (beta testing) will be conducted with 20 patients with AUD and the clinicians who care for them to assess its effect on shared decision making. PUBLIC HEALTH IMPACT: This study will develop an innovative tool for engaging patients with AUD in treatment. Moreover, this line of research has the potential to transform the management of AUD in health care settings, moving beyond the current non- individualized approach of "referral to treatment" to a patient-centered approach based on shared decision making. Such a transformation could bring patient-centered care to AUD management in medical settings.