INFORMED DECISION MAKING IN OLDER PATIENTS AND SURGEONS

老年患者和外科医生的明智决策

• 批准号: 6533902
• 负责人: WENDY LEVINSON
• 金额: $ 66.82万
• 依托单位: NATIONAL OPINION RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6533902
• 关键词: behavioral /social science research tag; clinical research; decision making; developmental psychology; geriatrics; human old age (65+); human subject; informed consent; orthopedics; patient care personnel relations; psychological aspect of aging; satisfaction

DESCRIPTION: As the population ages, elderly patients are confronted with difficult decisions about medical care. Communication between physicians and elderly patients is critical in helping patients make informed choices particularly about major interventions, like surgery. Communication to help patients make informed choices is not only imperative from an ethical and legal perspective, but effective communication between physicians and patients can improve the outcomes of care and patient satisfaction. This proposal builds on prior work by the investigators in which they developed and tested a framework to assess the informed decision-making (IDM) conversations in routine office visits. The proposal is collaboration between the researchers and the American Academy of Orthopedic Surgeons (AAOS), a membership organization of 25,000 surgeons. The specific goals are: 1) To assess the IDM communication skills of practicing orthopedic surgeons during routine office visits with their elderly patients (>65 years). This will be done by audio taping; routine visits with 100 surgeons and 1000 patients in the Chicago area. 2) To evaluate the association between IDM performance, surgeon, patient and visit characteristics. Surgeon characteristics will include a) demographics, b) attitudes toward older patients (ageism), participatory decision-making, and fear of litigation and c) prior communication training. Patient characteristics will include a) demographics (age, gender, race, SES) b) attitudes toward participation in decision making and c) health status. Visit characteristics will include a) length of the visit and b) presence of a third person (child, spouse) in the room. 3) To evaluate the association between surgeons IDM and patient satisfaction. Focus groups of elderly patients will review previously developed IDM criteria and provide input to ensure the criteria are "elder sensitive." 100 orthopedic surgeons' will be recruited and audio taped with 1000 patients (10 per surgeon) in the office setting. Sources of data will include a) the audiotapes, b) surgeon and patient questionnaires. The tapes will be coded to identify each decision and will be rated for the presence or absence of the appropriate IDM criteria. The association between surgeons' IDM performance, surgeon, patient, and visit characteristics will be assessed using hierarchical logistic regression. The study will be the first large data set of actual communication between surgeons and older patients and fills a major gap in knowledge about IDM with the elderly. The study also forms the scientific foundation of a major education initiative by the AAOS designed to improve the communication skills of surgeons and ultimately the care of patients.

描述：随着人口的年龄，老年患者面临 关于医疗服务的艰难决定。医师与 老年患者对于帮助患者做出明智的选择至关重要 特别是关于手术等重大干预措施。沟通以提供帮助 患者做出明智的选择不仅是道德和 法律观点，但医生与患者之间的有效沟通 可以提高护理和患者满意度的结果。这个建议 基于调查人员的先前工作，他们开发并测试了 评估知情决策（IDM）对话的框架 例行办公室访问。该建议是研究人员之间的合作 以及美国骨科医生学院（AAOS），会员资格 组织25,000名外科医生。具体目标是：1）评估IDM 常规办公室期间骨科医生执业的沟通技巧 与老年患者访问（> 65岁）。这将通过音频完成 录音；芝加哥与100名外科医生和1000名患者进行例行探访 区域。 2）评估IDM表现，外科医生，患者之间的关联 并访问特征。外科医生的特征将包括a） 人口统计，b）对老年患者（年龄歧视）的态度，参与式 决策以及对诉讼和c）事先沟通培训的恐惧。 患者特征将包括a）人口统计学（年龄，性别，种族，SES） b）参与决策和c）健康状况的态度。 访问特征将包括a）访问的长度和b）存在 房间里的第三人称（孩子，配偶）。 3）评估关联 在外科医生IDM和患者满意度之间。老年人的焦点小组 患者将审查先前开发的IDM标准，并提供输入 确保标准“对老年人敏感”。 100个骨科医生将是 在办公室招募和音频录制了1000名患者（每位外科医生10名） 环境。数据源将包括a）录音带，b）外科医生和 病人问卷。磁带将进行编码以确定每个决定和 将根据适当的IDM标准进行评级。这 外科医生的IDM表现，外科医生，患者和访问之间的关联 特征将使用层次逻辑回归进行评估。这 研究将是第一个大型数据集之间的实际通信 外科医生和老年患者，并填补了有关IDM知识的主要空白 老人。这项研究还构成了专业的科学基础 AAO的教育计划旨在提高沟通能力 外科医生，最终的护理。