Research Center of the CHUQ, Saint-Francois d'Assise Hospital, and Department de médecine familliale, University Laval, Quebec City, Canada.
BMC Med Inform Decis Mak. 2011 Mar 9;11:17. doi: 10.1186/1472-6947-11-17.
Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users.
METHODS/DESIGN: We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable), and will include new themes suggested by the data (inductive analysis). Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings.
This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It is the first step in the development and implementation of a new tool that should facilitate decision making in clinical practice.
将证据应用于临床实践是循证实践中最具挑战性的步骤之一。医疗保健专业人员在解释证据并将其转化为患者方面存在困难。决策框是在医疗保健专业人员与患者见面之前为他们提供的诊断、治疗和预防健康干预措施最重要的益处和危害的摘要。我们的假设是，决策框将使临床医生能够帮助患者做出基于价值的知情决策。通过充当入门书，这些盒子将增强基于证据的实践的应用，并在临床遇到时增加共同决策。本研究的目的是为开发决策框提供框架，并测试其对用户的价值。
方法/设计：我们将首先根据风险沟通研究回顾，为 10 种临床情况或主题开发决策框原型。我们将向分布在两个焦点小组中的 16 名家庭医生和分布在四个焦点小组中的 32 名患者展示两个原型。我们将使用用户体验模型框架来探索用户对每个原型的内容和格式的看法。所有讨论都将被转录，两名研究人员将对数据进行独立的混合演绎/归纳主题定性分析。编码方案将根据用户体验模型的七个主题（有价值、可用、可信、有用、理想、可及和可查找）预先制定，并将包括数据中提出的新主题（归纳分析）。关键发现将使用有关改进风险沟通工具设计的其他出版物进行三角测量。根据我们的发现，将对所有 10 个决策框进行修改。
本研究将为开发和测试决策框提供一个强大的框架，为医疗保健专业人员和患者提供服务。这是开发和实施新工具的第一步，该工具应有助于临床实践中的决策制定。
