Institute for Health Services and Health System Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany.
Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany.
JMIR Res Protoc. 2024 Nov 4;13:e57611. doi: 10.2196/57611.
Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking.
The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation.
The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs.
The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026.
The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57611.
临床实践指南（CPGs）旨在协助医疗保健专业人员进行医疗决策，但它们通常缺乏对共享决策（SDM）原则的有效整合，以反映患者的价值观和偏好，尤其是在偏好敏感的 CPG 建议方面。为了解决这一不足并通过 CPG 促进 SDM，有人提出将患者决策辅助工具（PDAs）纳入 CPG 作为一项重要策略。然而，目前缺乏系统识别和优先考虑与 SDM 相关的 CPG 建议及其相关决策支持工具的方法。
该项目的目的是开发（1）一种用于系统地识别和优先考虑 SDM 被认为特别相关的 CPG 建议的工具，以及（2）一个支持实际 SDM 实施的 PDA 平台。
该项目由 6 个工作包（WP）组成。它嵌入在德国医疗保健背景中，但具有国际重点。在 WP1 中，我们将在文献数据库和灰色文献来源中进行范围审查，以确定在 CPG 背景下通过 PDAs 促进 SDM 所使用的方法。在 WP2 中，我们将与 CPG 专家进行半结构化访谈，以更好地理解偏好敏感性的概念，并确定通过 CPG 促进 SDM 的策略。WP3 是一项包括 SDM 专家的调查和焦点小组的改良 Delphi 研究，旨在定义和操作偏好敏感性。基于 Delphi 研究的结果，我们将为 CPG 中的关键问题制定优先级排序的方法。在 WP4 中，我们将开发该工具。将创建、测试和迭代改进一个用于识别最相关的 SDM 的 CPG 建议的相关项目清单，并编写用户手册。在 WP5 中，我们将开发一个用于创建和数字化德语 PDAs 的平台，以支持在临床就诊期间实际应用 SDM。WP6 将通过使用新开发和修订的 CPG 来测试该工具，从而完成该项目。
勃兰登堡医学院伦理委员会批准了该项目（165122023-ANF）。一个国际多学科咨询委员会参与指导 CPG 和 SDM 方面的工具开发。患者伙伴自始至终都参与其中，考虑到患者视角在 SDM 中的重要作用。截至 2024 年 2 月 20 日，我们目前正在评估文献参考文献，以确定是否符合纳入范围审查的标准（WP1）。预计该项目将于 2026 年 12 月 31 日完成。
该工具将使 CPG 开发人员能够系统地将 SDM 方面纳入 CPG 开发，从而为医患互动提供基于指南的支持。CPG 工具和 PDA 平台将共同创建 CPG、SDM 和 PDAs 之间的系统联系，这可能有助于在临床实践中促进 SDM。
国际注册报告标识符（IRRID）：DERR1-10.2196/57611。
