Elwyn Glyn, Rasmussen Julie, Kinsey Katharine, Firth Jill, Marrin Katy, Edwards Adrian, Wood Fiona
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
J Eval Clin Pract. 2018 Feb;24(1):56-64. doi: 10.1111/jep.12665. Epub 2016 Nov 16.
Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use.
Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids.
We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients.
In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice.
After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways.
临床诊疗中用于向患者说明治疗方案风险与益处的工具已被证明可促进共同决策。然而，我们并不清楚临床医生如何看待这些工具，以及他们认为患者对使用这些工具会作何反应。
我们的目标是研究临床医生对于旨在支持患者和临床医生就治疗方案进行协作与商讨的工具（即选项网格决策辅助工具）的可能使用情况及实际使用情况的看法。
我们对一项针对膝关节骨关节炎的选项网格决策辅助工具试验干预阶段所进行的定性访谈进行了主题分析。在6名参与试验的临床医生使用该工具之前以及他们与6名患者使用该工具之后，分别对他们进行了访谈。
在首次访谈中，临床医生表示担心该工具会导致诊疗时间延长、患者对参与决策产生抵触情绪以及潜在的信息过载。在第二次访谈中，经过最少的培训后，临床医生报告称该工具改变了他们通常的沟通方式，并且将其整合到实践中总体上是可接受且有帮助的。
在体验了选项网格的使用之后，临床医生更愿意在与患者的临床诊疗中使用这些工具。如何以最佳方式向临床医生介绍选项网格并将其应用于实践，需要仔细考虑背景、工作流程和临床路径。
