Physician Perspectives Regarding the Use of Shared Decision-Making in the Emergency Department

 描述（由申请人提供）：本研究的目的是检查急诊科（艾德）供应商的观点，关于在他们的实践中使用共同决策。共享决策（SDM）是一种协作过程，允许患者/护理人员及其提供者共同做出医疗保健决策，并且不仅作为道德要求，而且作为一种增加知情决策，降低资源利用率，提高患者安全性和风险沟通的方法，并鼓励患者参与和以患者为中心的护理。围绕增加患者参与的好处的政策建议和患者倡导一直在增长。在美国，急诊科每年接待近1.3亿名患者，但目前还不清楚急诊科（艾德）提供者在多大程度上让患者参与决策，因为迄今为止还没有这方面的研究。本研究的主要目的是探讨艾德提供者对SDM的态度，以了解：1。他们对SDM的一般态度是什么，他们什么时候使用它？2.在艾德中使用SDM的障碍是什么？3.在艾德中使用SDM的促进因素是什么？4.哪些临床场景适合使用SDM？本研究的结果将是对这些问题的答案进行定性分析，并创建一份问卷，以在更大和更有代表性的艾德护理提供者群体中评估这些概念。为了实现这些目标，调查团队将对来自不同实践环境的艾德医生进行半结构化访谈。将通过定性分析得出关于在艾德中使用SDM的障碍和促进因素的假设，并将制定和认知测试问卷来测试这些假设。这R 03建立在调查小组的广泛经验，研究病人和供应商的态度和偏好。这项研究将有助于我们了解医生的态度，同时将为未来的干预研究，特别是那些希望改善SDM干预措施的实施提供基础。最后，这项研究映射到AHRQ的使命，使医疗保健更安全，更高的质量，更容易获得，公平，并通过寻求了解和解决的障碍，实施SDM，这可能直接影响这些更高的目标。此外，由于许多AHRQ的优先人群在艾德接受了不成比例的护理，这项研究有可能将SDM扩展到尚未看到其益处的患者，从而可能改善护理和结果。

 DESCRIPTION (provided by applicant): The objective of this study is to examine Emergency Department (ED) providers' perspectives regarding the use of Shared Decision-Making in their practice. Shared Decision-Making (SDM) is the collaborative process that allows patients/caregivers and their providers to make healthcare decisions together, and has gained increasing traction not only as an ethical imperative, but as a method that increases informed decision-making, decreases resource utilization, improves patient safety and the communication of risk, and encourages patient engagement and patient-centered care. Policy recommendations and patient-advocacy centered around the benefits of increased patient-engagement have been growing. Emergency Departments in the United States are the site of nearly 130 million patient encounters each year, but it is unclear to what extent Emergency Department (ED) providers are involving patients in decision-making, as there has been no research in this area to date. The primary objective of this study is to explore ED providers' attitudes regarding SDM in order to understand: 1. What are their general attitudes towards SDM, and when do they use it? 2. What are the barriers to using SDM in the ED? 3. What are the facilitators to using SDM in the ED? 4. Which clinical scenarios lend themselves to the use of SDM? The outcome of this study will be a qualitative analysis of the answers to these questions, and the creation of a questionnaire to assess these concepts in a larger and more representative group of ED care providers. To accomplish these objectives the investigative team will conduct semi-structured interviews with ED physicians from a diverse group of practice settings. Hypotheses regarding barriers and facilitators to using SDM in the ED will be generated through the qualitative analysis, and a questionnaire to test these hypotheses will be developed and cognitively tested. This R03 builds on the investigative team's extensive experience studying patient and provider attitudes and preferences. This study will contribute to our understanding of physicians' attitudes and at the same time will provide the foundation for future interventional studies, particularly those looking to improve implementation of SDM interventions. Finally, this study maps to AHRQ's mission of making health care safer, higher quality, more accessible, equitable, and affordable by seeking to understand and address the barriers to the implementation of SDM, which can directly affect these higher goals. Additionally, as many of the AHRQ's priority populations receive a disproportionate amount of care in the ED, this study has the potential to expand SDM to patients who have not yet seen its benefits, potentially improving care and outcomes.