University of California, Davis School of Medicine, 1 Shield Avenue, Sacramento, CA, USA,
J Gen Intern Med. 2013 Nov;28(11):1410-9. doi: 10.1007/s11606-013-2419-z. Epub 2013 May 7.
Shared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.
In July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.
Two-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.
Sixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).
Panelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.
Highly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.
Conference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers.
共同决策可改善前列腺癌筛查（PrCS）方面符合价值一致性的决策制定。然而，对于医生和低危男性来说，PrCS 讨论仍然复杂、具有挑战性，且常常涉及情绪问题。
2011 年 7 月，美国疾病控制与预防中心召集了一个多学科专家小组，确定优先事项供供资金机构和开发团体使用，以促进处于前列腺癌低危的男性及其医生之间基于证据、符合价值一致性的决策。
在佐治亚州亚特兰大举行为期两天的多学科专家小组会议，进行结构化讨论和正式共识程序。
16 名小组成员代表了不同的专业（初级保健、肿瘤内科、泌尿科）、学科（社会学、沟通、医学教育、临床流行病学）和市场部门（患者权益团体、联邦供资机构、指南制定组织）。
小组成员使用指导互动和评估模型来确定和评估可能改善医生、患者和卫生系统/社会的 PrCS 讨论和决策的策略。疗效定义为每个策略影响结果的可能性。努力程度定义为开发、实施和维持策略的相对工作量。使用群组处理软件（ThinkTank（TM））对每个策略进行评分（1-7 分制；7=最高分）。对于每个小组，干预策略被分为财务/监管、教育、沟通或态度杠杆。对于每个策略，都确定了障碍。
提高符合价值一致性的共同决策（SDM）的高排名策略包括：改变门诊就诊补偿以奖励 SDM；为医生和患者开发基于证据、技术辅助、服务点工具；重新构建混淆的前列腺癌筛查信息；提供就诊前决策支持干预；利用电子健康记录促进基准/最佳实践；为医生提供更多关于符合价值一致性决策的培训；并使用再认证来促进培训。
会议结果提出了一组专家共识策略，有望改善符合价值一致性的前列腺癌筛查决策。此外，用于达成一致的方法提供了一个围绕这个和未来有争议的癌症筛查问题进行成功合作的模型，这可能引起供资机构、教育者和政策制定者的兴趣。
