Eder Michelle, Ivlev Ilya, Lin Jennifer S
US Preventive Services Task Force Scientific Resource Center, Kaiser Permanente Center for Health Research, Portland, Oregon.
MDM Policy Pract. 2021 Dec 19;6(2):23814683211067522. doi: 10.1177/23814683211067522. eCollection 2021 Jul-Dec.
This methods project was conducted to support the US Preventive Services Task Force's (USPSTF) consideration of how information pertinent to shared decision making (SDM) can be best communicated in its recommendations. The project included a literature scan to identify SDM frameworks, audit of six USPSTF recommendations to judge the completeness of SDM communication, input from eight SDM experts on the most helpful SDM guidance to provide in USPSTF recommendations, and review of USPSTF recommendations and evidence reports to establish criteria for identifying topics that would most benefit from additional communication resources. We identified eight SDM frameworks and selected one to guide the audit of USPSTF recommendations. All six recommendations include SDM elements related to the patient's role in decision making, preventive service being considered, pros and cons of options, uncertainties about benefits and harms, and importance of patient preferences. Two SDM elements are not routinely communicated in the recommendations-identification of screening or initiating preventive medication as an alternative and the importance of patient understanding of options. Experts offered suggestions for essential SDM elements to address, such as assessing decisional conflict to measure patient uncertainty in choosing an option and highlighting uncertainty in estimates of benefit and harm, credibility of the evidence base, precision of estimates, and applicability to the individual patient. We developed six criteria for selection of USPSTF recommendations to supplement with a communication resource. The findings of this project can assist the USPSTF and other clinical guideline developers in incorporating SDM information in recommendations and determining which topics would most benefit from additional communication resources to support clinicians in engaging patients in SDM.
开展该方法项目是为了支持美国预防服务工作组（USPSTF）考虑如何在其建议中最好地传达与共同决策（SDM）相关的信息。该项目包括文献检索以确定SDM框架、对六项USPSTF建议进行审核以判断SDM沟通的完整性、八位SDM专家就USPSTF建议中最有帮助的SDM指导提供意见，以及审查USPSTF建议和证据报告以确立识别最能从额外沟通资源中受益的主题的标准。我们识别出八个SDM框架，并选择了一个来指导对USPSTF建议的审核。所有六项建议都包含与患者在决策中的角色、正在考虑的预防服务、选项的利弊、益处和危害的不确定性以及患者偏好的重要性相关的SDM要素。有两个SDM要素在建议中未常规传达——将筛查或开始预防性用药作为一种替代方案的识别以及患者对选项理解的重要性。专家们就需要解决的基本SDM要素提出了建议，比如评估决策冲突以衡量患者在选择选项时的不确定性，以及突出益处和危害估计中的不确定性、证据基础的可信度、估计的精确性以及对个体患者的适用性。我们制定了六项标准来选择USPSTF建议以补充沟通资源。该项目的研究结果可帮助USPSTF和其他临床指南制定者在建议中纳入SDM信息，并确定哪些主题最能从额外的沟通资源中受益，以支持临床医生让患者参与SDM。
