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Teaching Diverse Orthopaedic Patient Populations About Deliberative Decision Making Skills: Testing a Design Strategy for Online Patients' Decision Aids.

机译：向各种骨科患者群体讲授协商性决策技巧：测试在线患者决策辅助的设计策略。

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摘要

Problem Statement;Effective patients' decision aids (PtDAs) help patients understand clinical information and reduce decisional conflict. PtDAs that also explicitly provide guidance through four "Deliberative Steps" may achieve additional gains in preparation for decision making.;Methods;Two versions were created of a web-based PtDA regarding the management of chronic knee osteoarthritis. The Information-Provision version provided clinical information (with optional "More Information" links to additional detail) and implicit deliberative guidance. The Information+Deliberation version provided the same clinical information and links, as well as explicit guidance through four Deliberative Steps: 1) Information Comprehension; 2) Values Clarification; 3) Consideration of Social Resources; and 4) Formation of an Action Plan. At each step, an optional interactive "Engagement Activity" was offered. In both versions, the program tracked selection of the information links; in the Information+Deliberation version, the program tracked engagement with the optional activities.;After pilot-testing, both versions were compared (N = 126) in terms of post-PtDA Preparation for Decision Making, Decision Self-efficacy, and Decisional Conflict. Sub-groups using the "More Information" links and the "Engagement Activities" were characterized.;Results;There were no statistically significant across-study-group differences in mean Preparation for Decision Making, Decision Self-efficacy, or Decisional Conflict scores.;Overall (N = 126), 46% of participants selected the "More Information" links. This sub-group was primarily female, Caucasian, college-degreed, reported higher decisional conflict, and had viewed the Information+Deliberation version.;In the Information+Deliberation study group (n = 64), 43% used the "Engagement Activities". This sub-group was also female, Caucasian, college-educated, reported higher levels of pain and higher decisional conflict, as well as more familiarity with the decision. The percentages of engaging at each of the 4 Steps were 14%, 27%, 13%, and 22%, respectively.;Conclusions;In this clinical context, explicit guidance may not improve all patients' preparation for decision making, on average. Future studies should assess whether Type II error has occurred. Different "Deliberative Styles" may exist, and may benefit more/less from explicit guidance and optional detailed clinical information and interactive engagement.
机译：问题陈述；有效的患者决策辅助工具（PtDA）可帮助患者了解临床信息并减少决策冲突。也通过四个“协商步骤”明确提供指导的PtDA可能会为决策制定做准备，从而获得更多收益。方法：创建了两个版本的基于Web的PtDA，用于管理慢性膝关节骨关节炎。信息提供版本提供了临床信息（带有可选的“更多信息”链接以提供更多详细信息）和隐含的协商指南。信息咨询版提供了相同的临床信息和链接，并通过四个协商步骤提供了明确的指导：1）信息理解； 2）价值澄清； 3）社会资源的考虑； 4）制定行动计划。在每个步骤中，都会提供一个可选的交互式“参与活动”。在这两个版本中，该程序都跟踪信息链接的选择。在信息+协商版本中，该程序会跟踪与可选活动的互动。；在进行了试点测试之后，根据PtDA后的决策准备，决策自我效能和决策冲突对这两个版本进行了比较（N = 126）。 。结果：在研究的平均准备，决策自我效能或决策冲突得分方面，各研究组之间在统计学上没有显着差异。分组使用“更多信息”链接和“参与活动”进行分组。 ；总体（N = 126），有46％的参与者选择了“更多信息”链接。该子组主要是女性，高加索人，大学学历的白人，报告了较高的决策冲突，并且查看过信息+商议版本。；在信息+商议研究组（n = 64）中，有43％的人使用了“参与活动” 。这个小组也是女性，高加索人，受过大学教育，报告的疼痛水平更高，决策冲突更高，对决策的熟悉程度更高。在这四个步骤中，每个步骤的参与百分比分别为14％，27％，13％和22％。；结论；在这种临床情况下，明确的指导可能平均不会改善所有患者的决策准备。未来的研究应评估是否发生II型错误。可能存在不同的“协商风格”，并且可以从明确的指导和可选的详细临床信息以及互动参与中受益更多/更少。

著录项

  • 作者

    Hoffman, Aubri S.;

  • 作者单位

    Dartmouth College.;

  • 授予单位 Dartmouth College.;
  • 学科 Health Sciences Public Health.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 287 p.
  • 总页数 287
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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