Shared Decision-Making for Elderly Depressed Primary Care Patients

老年抑郁初级保健患者的共同决策

基本信息

批准号：
8269068
负责人：
PATRICK J RAUE
金额：
$ 35.33万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-17 至 2014-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8269068
关键词：
Acute Address Adherence Age Aged, 80 and over Alcohol abuse Antidepressive Agents Belief Caring Characteristics Clinic Clinical Clinical Research Computerized Medical Record DSM-IV Data Decision Making Depressed mood Diagnosis Disease Disease remission Effectiveness Elderly Eligibility Determination Exhibits Family Feeling hopeless Goals Hamilton Rating Scale for Depression Health Health behavior change Hospitals Human Resources Impaired cognition Individual Intention Intervention Interview Knowledge Malignant Neoplasms Measures Mediating Mediator of activation protein Medical Mental Depression Mental Health Mental disorders Modeling NIH Program Announcements National Institute of Mental Health Nature New York City Nurses Outcome Patients Personality Traits Persons Pharmaceutical Preparations Physicians Population Primary Care Physician Primary Health Care Process Psychiatric therapeutic procedure Psychotherapy Randomized Randomized Controlled Trials Recruitment Activity Research Role Screening procedure Severities Solo Practices Staging Structure Substance abuse problem Suicide Symptoms Telephone Testing Training Treatment Cost Treatment outcome Trust Uncertainty Visit Work active method age group base compliance behavior depressive symptoms empowered empowerment expectation follow-up group intervention improved indexing innovation meetings mental state nursing intervention patient oriented preference public health relevance satisfaction shared decision making standard care theories treatment adherence treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Shared decision-making (SDM), in contrast to traditional medical decision-making, involves a collaborative process whereby patients articulate personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. SDM may be particularly relevant for depressed individuals, as it seeks to enhance their autonomy and empowerment in a manner that directly addresses the helplessness and hopelessness associated with depression. Shared decision-making interventions are being developed for depression in primary care, but have yet to be adequately tested. It is also unknown whether the same premises regarding shared decision-making's ability to enhance autonomy and empowerment pertain to elderly populations. The proposed study will evaluate the impact of a three-session SDM nursing intervention among depressed elderly primary care patients, in comparison to Usual Care (UC), on patient adherence to antidepressant medication or psychotherapy and on reduction in depressive symptoms. The focus of the SDM intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that can be successfully implemented. Based on our prior work that demonstrated the impact of patients' a priori treatment preferences on treatment initiation and adherence, we propose to conduct a randomized controlled trial of elderly depressed primary care patients to determine the impact of SDM on treatment adherence and reduction in depressive symptoms. The study randomizes 30 physicians from Lincoln Hospital in the Bronx, a large ethnically diverse primary care clinic, to either Shared Decision-Making (SDM) or the Usual Care (UC) comparison condition. A total of 210 depressed (PHQ-9>15) geriatric patients whose physicians' recommend starting depression treatment, will receive either SDM or UC according to physician randomization. Subjects will be assessed at baseline and at weeks 4, 8, 12, and 24 to determine treatment adherence and depressive status. If SDM is effective, it may serve as a brief independent intervention by practice nurses, and will provide a platform to tailor and disseminate the model throughout a variety of primary care practice settings and populations. PUBLIC HEALTH RELEVANCE: Shared decision-making, in contrast to traditional medical decision-making, involves a collaborative process whereby patients share personal values and preferences and clinicians provide information to arrive at a mutually-agreed upon treatment decision. The proposed study will evaluate the impact of a shared decision- making nursing intervention among depressed elderly primary care patients on patient adherence to depression treatment and on improvement in depression. The focus of the intervention is to empower elderly depressed primary care patients and help them efficiently arrive at a treatment decision that they can successfully implement.

描述（由申请人提供）：与传统的医疗决策相比，共享决策 (SDM) 涉及协作过程，患者阐明个人价值观和偏好，临床医生提供信息以达成双方同意的治疗决策。 SDM 可能与抑郁症患者特别相关，因为它寻求以直接解决与抑郁症相关的无助和绝望的方式增强他们的自主权和赋权。初级保健中针对抑郁症的共同决策干预措施正在开发中，但尚未得到充分测试。还不清楚关于共同决策增强自主权和赋权的能力的相同前提是否适用于老年人口。拟议的研究将评估与常规护理 (UC) 相比，三期 SDM 护理干预对抑郁老年初级保健患者的影响，对患者坚持抗抑郁药物或心理治疗以及减少抑郁症状的影响。 SDM 干预的重点是增强老年抑郁症初级保健患者的能力，帮助他们有效地做出可以成功实施的治疗决定。基于我们之前的工作证明了患者的先验治疗偏好对治疗开始和依从性的影响，我们建议对老年抑郁初级保健患者进行随机对照试验，以确定 SDM 对治疗依从性和减少抑郁症状的影响。该研究将来自布朗克斯区林肯医院（一家大型种族多元化初级保健诊所）的 30 名医生随机分为共享决策 (SDM) 或常规护理 (UC) 比较条件。总共 210 名抑郁症 (PHQ-9>15) 老年患者，其医生建议开始抑郁症治疗，将根据医生随机化接受 SDM 或 UC 治疗。将在基线以及第 4、8、12 和 24 周对受试者进行评估，以确定治疗依从性和抑郁状态。如果 SDM 有效，它可以作为执业护士的简短独立干预措施，并将提供一个平台，在各种初级保健实践环境和人群中定制和传播该模型。公共卫生相关性：与传统医疗决策相比，共享决策涉及协作过程，患者分享个人价值观和偏好，临床医生提供信息以达成双方同意的治疗决策。拟议的研究将评估抑郁症老年初级保健患者的共同决策护理干预对患者对抑郁症治疗的依从性和抑郁症改善的影响。干预的重点是赋予老年抑郁症初级保健患者权力，帮助他们有效地做出可以成功实施的治疗决定。