Validation of a Framework for Shared Decision-Making in Pediatrics

项目总结 共享决策(SDM)的一个主要目标是确保医疗决策纳入 受医疗决定影响的患者的偏好。SDM和支持其使用的工具已经 发现可以提高患者对结果、风险以及他们选择与他们的选择相匹配的选择的知识 价值观。因此，SDM已成为医学上的标准决策模型。然而，它的 儿科领域的实施受到了阻碍，因为对SDM是如何 应该体现在儿科常见的决策场景中。[例如，在以下方面实施SDM 儿科必须适应多个目标，例如保护儿童，尊重正在形成的自主性 青少年，尊重父母的价值观和决策权，这与 在成人中实施SDM，其唯一目标是保护或促进患者自主]。的确有 没有在儿科实施SDM的模式来全面解决这些和其他问题 儿科决策的共同特征。 该项目的主要目标是从经验上改进在儿科实施SDM的框架 使用跨多个儿科学科[和儿童年龄]的不同决策方案。这 框架包括4个步骤。前3个步骤向临床医生提出一个问题，而答案将指导 沿框架进一步推进的临床医生(步骤1(医疗合理性)：该决定是否包括 一个医学上合理的选择？；第二步(利益-负担)：一个选择是否具有有利的医疗好处- 与其他选项相比的负担比率；步骤3(偏好敏感度)：偏好敏感度如何 选项？)。步骤4(校准)提供了具体的SDM方法的指导，用于在 根据对步骤1-3的答复以及目前存在的其他决策特点进行审议。 我们的具体目标是(1)评估儿科SDM框架在一系列范围内的适用性 通过(A)对以问题为导向的医疗接触进行录像(N=[30])，对医疗决定[和儿童年龄]进行记录 涉及6个儿科临床服务的儿童[≤17](颅面、新生儿、肺部、 血液学/肿瘤学、儿科重症监护和普通儿科/医院医学)，(B)开展[75] 与临床医生(N=30)、父母(N=30)[和11-17岁儿童(N=15)]参与者的会后访谈 使用视频刺激的回忆来找出可持续发展管理框架中的差距，以及(C)修订框架 因此；(2)评估修订后的儿童SDM框架的表面和内容的有效性 组织4个重点小组，就经修订的框架的内容和组成部分征求意见。 此R03应用程序将为在儿科实施SDM的有效流程提供证据。这个 这一建议的结果将为未来由R01资助的研究提供信息，以开发、评估和前瞻性测试工具 目的：测量儿科的SDM。

PROJECT SUMMARY A primary objective of shared decision-making (SDM) is to ensure medical decision-making incorporates the preferences of the patients affected by the medical decision. SDM and tools that support its use have been found to improve patients' knowledge of outcomes, risks, and their selection of an option that matches their values. Consequently, SDM has emerged as the standard decision-making model in medicine. However, its implementation in the field of pediatrics has been hampered by an incomplete understanding of how SDM should manifest in decision-making scenarios common to pediatrics. [For instance, implementation of SDM in pediatrics must accommodate multiple goals, such as protecting the child, honoring the emerging autonomy of adolescents, and respecting parental values and decision-making authority, which distinguishes it from the implementation of SDM with adults where the singular goal is to protect or promote patient autonomy]. There is no model for the implementation of SDM in pediatrics that comprehensively addresses these and other features common to pediatric decision-making. The primary goal of this project is to empirically refine a framework for implementing SDM in pediatrics using a diverse set of decision-making scenarios across multiple pediatric disciplines [and child ages]. This framework includes 4 steps. The first 3 steps pose a question to the clinician, with the answers directing the clinician further along the framework (Step 1 (Medical Reasonableness): does the decision include more than one medically reasonable option?; Step 2 (Benefit-Burden): does one option have a favorable medical benefit- burden ratio compared to other options?; Step 3 (Preference Sensitivity): how preference-sensitive are the options?). Step 4 (Calibration) provides direction on the specific SDM approach to use for the decision under consideration based on the answers to Steps 1-3 as well as other decisional characteristics present. Our specific aims are to (1) to assess the applicability of the pediatric SDM framework across a range of medical decisions [and child ages] by (a) videotaping problem-oriented medical encounters (N=[30]) involving children [≤17] years old in 6 pediatric clinical services (craniofacial, neonatology, pulmonary, hematology/oncology, pediatric intensive care, and general pediatrics/hospital medicine), (b) conducting [75] post-encounter interviews with clinician (N=30), parent (N=30) [and 11-17 year old child (N=15)] participants using video-stimulated recall to identify gaps in the SDM framework, and (c) revising the framework accordingly; (2) to assess the face and content validity of the revised pediatric SDM framework by conducting 4 focus groups to elicit input on the content and components of the revised framework. This R03 application will provide evidence for a valid process for implementing SDM in pediatrics. The results of this proposal will inform a future R01-funded study to develop, evaluate, and prospectively test a tool to measure SDM in pediatrics.