Role of decision aid desgin in single event decision making

通过量身定制的决策辅助工具促进共同决策 项目摘要 许多医疗决策是偏好敏感的，最佳选择部分取决于患者的态度 对替代治疗的风险和益处的认识。例如，对于一个患有 局限性前列腺癌可能取决于他有多强烈地想要避免阳痿的机会，或者取决于他如何 他决心从身体上切除癌症。一个理想的决定，因此，将与 充分了解患者的偏好。需要进行研究以确定帮助病人的最佳方法 将他们的偏好传达给他们的医生。使用两阶段策略，我们将测试以下方法： 提高患者讨论其偏好的意愿和能力，并提高一致性 他们对共同决策的渴望和他们所经历的参与类型之间的关系。在第一阶段，我们 将进行互联网研究，以测试几种新的方法来定制前列腺癌决策辅助（DA）， 目标是确定增加患者偏好感知显著性的干预措施。在我们 确定最佳干预措施后，我们将相应地修改我们目前的前列腺癌DA。第二阶段将 将这种新的定制DA与我们目前在新诊断的局部化男性中的非定制决策辅助进行比较 前列腺癌本研究将在两家医院（密歇根大学和安阿伯VA）进行， 将在前列腺活检时招募男性。定制DA的有效性将使用 定量和定性方法。主要的定量结果指标包括自我效能和 向医生传达治疗偏好的意图，参与决策的偏好， 决策中期望和实际参与的一致性，以及患者对他们相互作用的感知 和他们的医生。我们还将分析患者和医生之间的对话，以检查是否 定制的DA对患者和医生之间的交互有影响（例如，讨论病人的 偏好）。最后，我们将使用眼动追踪研究作为评估患者参与度的另一种方法 这项研究的结果使我们能够获得有关如何设计DA的前所未有的数据， 改善医患沟通。这将导致患者做出更明智的决定， 转可以为患者带来更好的身体和心理结果。

Promoting Shared Decision Making Through a Tailored Decision Aid PROJECT SUMMARY Many medical decisions are preference-sensitive, with the best choice depending in part on patient attitudes towards the risks and benefits of treatment alternatives. For example, the best treatment for a man with localized prostate cancer may depend on how strongly he wants to avoid the chance of impotence, or on how determined he is to physically remove the cancer from his body. An ideal decision, therefore, will be made with full awareness of patient preferences. Research is needed to determine the best methods for helping patients communicate their preferences to their physicians. Using a two-phase strategy, we will test methods for increasing patients' willingness and ability to discuss their preferences and for improving the concordance between their desires for shared decision making and the type of participation they experience. In Phase I, we will conduct Internet studies to test several novel ways of tailoring a prostate cancer decision aid (DA), with the goal of identifying interventions that increase the perceived salience of patient preferences. After we have determined the best interventions, we will modify our current prostate cancer DA accordingly. Phase II will then compare this new tailored DA to our current untailored decision aid in men with newly diagnosed localized prostate cancer. This study will be conducted at two hospitals (University of Michigan and Ann Arbor VA) and will recruit men at the time of their prostate biopsy. Effectiveness of the tailored DA will be determined using both quantitative and qualitative methods. Primary quantitative outcome measures include self-efficacy and intentions for communicating treatment preferences to physician, preference for participating in the decision, concordance of desired and actual participation in the decision, and patients' perceptions of their interaction with their physicians. We will also analyze conversations between patients and physicians to examine whether the tailored DA has an impact on the interaction between patients and physicians (e.g., discussion of patients' preferences). Finally, we will use eye-tracking studies as another method of accessing patient engagement with the DA. The results of this study allow us to have unprecedented data about how to design DAs to improve patient-physician communication. This will result in patients making more informed decisions, which in turn could result in better physical and psychological outcomes for patients.