SDMo – a measure of the occurrence of SDM in the care of patients with chronic conditions

项目摘要/摘要 共享决策(SDM)是患者和临床医生共同努力了解 患者的有问题的情况，并协作制定护理计划，使智力、实用和 作为对情况和个人个性的反应的情绪感。SDM的实践是广泛的 通过临床指南、组织和政府政策和倡议进行推广，这是一个特点 以病人为中心的护理。SDM的目标是通过增强 然而，事实证明，患者参与决策很难建立这种影响，部分原因是 衡量SDM的局限性。研究人员目前还没有他们需要的衡量标准来确定在任何 在患者-临床医生接触期间，使用SDM过程进行协作深思熟虑并形成护理计划。这个 由于缺乏概念和操作上的清晰度，确定SDM发生的能力受到很大限制 SDM、狭隘的测量框架以及对现有观察员和自我报告测量的限制， 特别是在慢性多发病的背景下。因此，在这项为期三年的研究中，包括 SDM、测量开发和验证以及以用户为中心的设计方面的专家-建议开发 基于理论、专家信息、用户测试、基于观察者的SDM发生度量(“SDMO”)和 评价其信度和效度。具体地说，这个应用程序的目标是开发一个全面的 使用现有文献和理论来捕捉可观察的过程和行为的项目集，这些过程和行为表明 SDM(目标1)；使用从目标1派生的候选项目，部署以用户为中心的设计流程，以开发 通过现场测试和改进的迭代过程，对SDM的发生情况进行可用和可行的测量 在以前收集的视频临床接触语料库上进行SDMO测量(目标2)；以及 评估SDMO测量的信度和效度(目标3)。完成这三个目标将导致 慢性多发病患者临床接触中SDM发生的有效测量，估计 测量的可靠性和有效性，以及用户测试的用户手册，其中将包括以下详细说明 每件物品、使用插图和带有视频剪辑的培训程序，以促进高度可靠的使用 其他研究人员对该仪器的研究。从长远来看，新措施SDMO将有助于揭开 SDM在多种慢性病患者护理中的真实患病率和提高质量 以及在这一优先人群中对SDM的研究的一致性。最终，一个全面、有效和可靠的 SDM的测量将允许临床研究人员严格测试SDM实践和SDM之间的关联 行为和身体健康结果，并促进基于新证据的临床实践改进。

PROJECT SUMMARY/ABSTRACT Shared decision making (SDM) is a process in which patients and clinicians work together to understand the patient’s problematic situation and collaboratively develop a plan of care that makes intellectual, practical, and emotional sense as a response to the situation and the individuality of the person. The practice of SDM is widely promoted through clinical guidelines, organizational and governmental policies and initiatives, and is a feature of patient-centered care. A goal of SDM is to improve health and behavioral outcomes through enhancing patients’ participation in decision making, however it has proven hard to establish this impact, in part due to limitations in measuring SDM. Researchers currently do not have the measures they need to determine if, in any patient-clinician encounter, a SDM process was used to collaboratively deliberate and form a plan of care. The ability to determine the occurrence of SDM is highly limited by a lack of conceptual and operational clarity around SDM, narrow measurement frameworks, and limitations to existing observer and self-reported measures, particularly in the context of chronic multimorbidity. Therefore, in this three-year study, the team—comprising experts in SDM, measure development and validation, and user-centered design—propose to develop a theoretically based, expert-informed, user-tested, observer-based measure of SDM occurrence (“SDMo”) and to estimate its reliability and validity. Specifically, the objectives of this application are to develop a comprehensive set of items using existing literature and theory to capture observable processes and behaviors indicative of SDM (Aim 1); using candidate items derived from Aim 1, to deploy a user-centered design process to develop a usable and feasible measure of SDM occurrence through an iterative process of field testing and refinement of the SDMo measure on a previously collected corpus of video-recorded clinical encounters (Aim 2); and to estimate the reliability and validity of the SDMo measure (Aim 3). Completion of these three aims will result in a usable measure of SDM occurrence in clinical encounters with patients with chronic multimorbidity, estimates of the measure’s reliability and validity, and a user-tested Users’ Manual that will include a detailed explanation of each item, illustrations for its use, and a training procedure with video clips that will promote highly reliable use of the instrument by other researchers. In the long-term, the new measure, SDMo, will contribute to uncovering the real prevalence of SDM in the care of patients with multiple chronic health conditions and improve the quality and consistency of research on SDM in this priority population. Ultimately, a comprehensive, valid, and reliable measure of SDM will allow clinical researchers to rigorously test associations between the practice of SDM and behavioral and physical health outcomes and facilitate improvements to clinical practice based on new evidence.