Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora.
Assuring Better Child Health and Development, Denver, CO.
Am J Speech Lang Pathol. 2022 May 10;31(3):1084-1094. doi: 10.1044/2021_AJSLP-21-00072. Epub 2021 Nov 3.
Despite increasing standardization of developmental screening and referral processes, significant early intervention service disparities exist. The aims of this article are to: (a) describe methods used to develop a decision support tool for caregivers of children with developmental concerns, (b) summarize key aspects of the tool, and (c) share preliminary results regarding the tool's acceptability and usability among key stakeholders.
Content and design of the decision support tool was guided by a systematic process outlined by the International Patient Decision Aid Standards (IPDAS) Collaborative. Three focus group interviews were conducted with caregivers ( = 7), early childhood professionals ( = 28), and a mix of caregivers and professionals ( = 20) to assess caregiver decisional needs. In accordance with the IPDAS, a prototype of the decision support tool was iteratively cocreated by a subset of caregivers ( = 7) and early child health professionals ( = 5).
The decision support tool leverages images and plain language text to guide caregivers and professionals along key steps of the early identification to service use pathway. Participants identified four themes central to shared decision making: trust, cultural humility and respect, strength-based conversations, and information-sharing. End-users found the tool to be acceptable and useful.
The decision support tool described offers an individualized approach for exploring beliefs about child development and developmental delay, considering service options within the context of the family's values, priorities, and preferences, and outlining next steps. Additional research regarding the tool's effectiveness in optimizing shared decision-making and reducing service use disparities is warranted.
尽管发育筛查和转介过程日益标准化，但仍存在显著的早期干预服务差距。本文的目的是：(a)描述为有发育问题儿童的照顾者开发决策支持工具所采用的方法，(b)总结工具的关键方面，以及 (c)分享关键利益相关者对工具可接受性和可用性的初步结果。
决策支持工具的内容和设计由国际患者决策辅助标准 (IPDAS) 协作组织概述的系统过程指导。对 7 名照顾者、28 名幼儿专业人员和 20 名照顾者和专业人员混合组进行了 3 次焦点小组访谈，以评估照顾者的决策需求。根据 IPDAS，决策支持工具的原型由一组照顾者 ( = 7) 和幼儿健康专业人员 ( = 5) 共同反复创建。
决策支持工具利用图像和通俗易懂的文本，指导照顾者和专业人员沿着早期识别到服务使用途径的关键步骤进行操作。参与者确定了共同决策的四个核心主题：信任、文化谦逊和尊重、基于优势的对话以及信息共享。最终用户发现该工具是可接受和有用的。
所描述的决策支持工具提供了一种个性化的方法，用于探讨对儿童发育和发育迟缓的信念，在家庭的价值观、优先事项和偏好的背景下考虑服务选择，并概述下一步。需要进一步研究该工具在优化共同决策和减少服务使用差距方面的有效性。
