Developing a Standardized Process Assessment for Relationship-Centered Shared Decision-Making (SPARCSdm)

项目总结

Project Summary This project's goal is to develop an assessment that captures the process of shared decision-making (SDM) for persons who cannot advocate for themselves because they lack the cognitive capacity to decide for themselves and the ability to communicate their wishes. Current SDM assessments are not designed for these individuals and generally focus on encounter outcomes rather than the process by which SDM unfolds. To address this knowledge gap, a team of multi-disciplinary researchers, healthcare stakeholders, and care partners will collaborate to design and test the observer-rated Standardized Process Assessment of Relationship-Centered Shared Decision-Making (SPARCSdm), informed by our relationship-centered SDM process model. In Aim 1, we will observe, interview and analyze patient- practitioner-care partner triad encounters where decisions are made. These observations will be used to define modifiable collaboration and information exchange skills, identify items and rating scales for the SPARCSdm, and design a prototype assessment including administration procedures. In Aim 2, assessors will be trained using an online, competency-based training developed specifically for this project; once trained, they will observe videotaped SDM encounters and separately score care partners and practitioner on the SPARCSdm. These data, analyzed using the many facets Rasch model (MFRM) to adjust for assessor severity/leniency and encounter complexity, will provide preliminary evidence of SPARCSdm psychometrics, facilitate appraisal of the assessment's conceptual and structural validity, and inform refinements of the online training. In Aim 3, we will apply the Knowledge to Action implementation science strategy to scale up the prototype for future testing by identifying supports and barriers, usability, and acceptability. This project advances care for persons with chronic disabilities and their care partners by developing a process assessment that is relationship-centric, inclusive of multiple perspectives, and user-friendly. As such, it is highly responsive to AHRQ's request for projects that develop an SDM process assessment, informed by a conceptual model, to capture multiple perspectives for priority populations such as persons with disabilities who need chronic care. This assessment is needed because clinical supervisors and medical educators currently struggle to identify when SDM has taken place and which practitioners and care partners need support with SDM skills. Attention to usability and integration of supports and barriers to implementation throughout the design process ensures this project will effectively set the stage for larger scale testing of the SPARCSdm, and longer-term, for measuring the effectiveness of intervention programs aimed at improving SDM.