Politi Mary C, Adsul Prajakta, Kuzemchak Marie D, Zeuner Rachel, Frosch Dominick L
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
J Eval Clin Pract. 2015 Apr;21(2):175-9. doi: 10.1111/jep.12269. Epub 2014 Oct 16.
RATIONALE, AIMS AND OBJECTIVES: Despite extensive evidence on the value of patient decision support interventions (DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice.
Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach.
Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site.
Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption.
原理、目的和目标：尽管有大量证据表明患者决策支持干预措施（DESIs）具有价值，但对于最佳的DESI形式尚无共识。评估临床医生对DESI形式的看法有助于促进其采用。本研究的目的是评估临床医生对DESI形式的看法及其在实践中的潜在用途。
对来自不同执业领域（内科、妇产科、外科、医学肿瘤学、急诊医学）的医生进行了半结构化定性访谈，以了解他们对患者DESI形式（数字形式与纸质形式）和给药时间的看法。问题还引出了态度背后的信念、感知的社会规范以及使用DESIs的自我效能感及其可行性。使用主题分析方法进行数据分析。
参与者指出了更全面的数字工具和更简短的纸质工具的优点，并认为它们可以相互补充。鉴于在这些充满情感的对话中需要讨论大量信息，参与者一致表示在会诊之外使用DESIs来补充关于癌症决策的临床讨论具有优势。参与者认为，与数字DESI相比，年龄较大和社会经济地位较低的患者更有可能使用纸质DESI。参与者还指出了与实践环境中计算机和互联网等可靠资源相关的挑战，而这些资源是在现场实施数字DESIs所必需的。
临床医生对DESIs价值的看法和意见可能因医生、患者和诊所特征的不同而有很大差异。一刀切的实施方法可能不可行，这表明需要灵活的方法为患者提供决策支持，以推动更广泛的采用。
