Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
J Hosp Med. 2018 Jul 1;13(7):453-461. doi: 10.12788/jhm.2909. Epub 2018 Feb 5.
Shared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM.
To assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services.
A 12-week, cross-sectional, single-blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews.
Two large quaternary care academic medical centers.
Thirty-five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics).
Observational study.
We used a 9-item Rochester Participatory Decision-Making Scale (RPAD) measured team-level SDM behaviors. Same-day interviews using a modified RPAD assessed patient perceptions of SDM.
Characteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow-through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9).
Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.
共同决策（SDM）可提高患者的参与度，并可能改善门诊医疗效果。然而，我们对住院患者的 SDM 知之甚少。
评估内科和儿科住院医师服务中住院轮班期间 SDM 的整体质量、提供者行为和背景预测因素。
这是一项为期 12 周的横断面、单盲观察性研究，研究了团队在轮班期间的 SDM 行为，随后对患者进行了半结构化访谈。
两个大型四级保健学术医疗中心。
35 个住院团队（18 个内科，17 个儿科）和 254 个独特的患者就诊（117 个内科，137 个儿科）。
观察性研究。
我们使用了 9 项罗切斯特参与式决策量表（RPAD）来衡量团队级别的 SDM 行为。使用改良后的 RPAD 进行当日访谈，评估患者对 SDM 的看法。
多元分析中与 SDM 增加相关的特征包括：服务、患者性别、轮班时间和每位患者的轮班时间（P<.05）。所有服务中最常见的行为包括解释临床问题和将医疗语言与患者的理解水平相匹配。观察到的最不常见的行为包括检查患者对自己观点的理解、检查遵医障碍和询问患者是否有问题。患者和监护人对 SDM 质量的评分明显高于同行观察者（9 分制，7.2 分对 4.4 分）。
改善住院患者 SDM 有很大的机会。团队规模、学习者人数、患者数量和要做出的决策类型并未影响 SDM，这表明即使是大型、繁忙的服务，如果经过适当的培训，也可以进行 SDM。
