Fay Mary, Grande Stuart W, Donnelly Kyla, Elwyn Glyn
Dartmouth Hitchcock Medical Center, Lebanon, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
Patient Educ Couns. 2016 Feb;99(2):236-42. doi: 10.1016/j.pec.2015.08.025. Epub 2015 Aug 24.
To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement.
We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention.
Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process.
Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making.
Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice.
评估一种旨在加强共同决策过程和家长参与度的简短问诊工具的影响、可接受性和可行性。
我们分析了临床问诊的视频记录，其中一半是在对四名临床医生进行如何使用选项网格的简短干预之前进行的，另一半是在干预之后进行的，采用基于观察者的共同决策测量方法。我们还分析了临床医生在接触干预四周后进行的半结构化访谈。
干预后观察者选项（5）得分更高，干预后平均分为33.9（标准差=23.5），而干预前平均分为16.1（标准差=7.1），显著差异为17.8（95%置信区间：2.4，33.2）。在使用该干预措施之前，临床医生使用同意书将包皮环切术作为默认做法。使用选项网格进行问诊赋予了家长和临床医生自主权，并促进了共同决策。临床医生报告称认识到该工具对他们沟通流程的积极影响。
选项网格等工具有可能使临床医生更容易实现共同决策。
问诊工具有可能改变实践。需要更多研究来测试它们在常规实践中的可行性。
