PDF(Pubmed)
Abstract：
Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners\' (GPs) and patients\' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care.
We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis.
Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source.
This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training.
The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis.
Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source.
This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training.
The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
摘要：
背景：遇到决策辅助（EDA）是可以支持共享决策（SDM）的工具，直到临床相遇。然而,这些工具的采用受到限制，因为它们很难生产，为了保持最新，并不能用于许多决定。MAGIC证据生态系统基金会创建了新一代的决策辅助工具，这些辅助工具通常是按照数字结构化指南和证据摘要制作的。在电子创作和出版平台(MAGICapp)中。我们探索了与初级保健中BMJ快速建议相关的五种选定决策辅助工具的全科医生（全科医生）和患者经验。
方法：我们应用了定性用户测试设计来评估全科医生和患者的用户体验。我们翻译了五个与初级保健相关的EDA，并观察了11名全科医生与患者使用EDA时的临床遭遇。我们在咨询后对每位患者进行了半结构化访谈，并在多次咨询后对每位全科医生进行了大声思考访谈。我们使用定性分析指南(QUAGOL)进行数据分析。
结果：对31次临床接触的直接观察和用户测试分析显示了总体积极的体验。EDA更好地参与决策，并为患者和临床医生带来有意义的见解。设计及其互动，多层结构使工具令人愉快和组织良好。困难的术语，规模和数量阻碍了对某些信息的理解，有时被认为过于专业化甚至令人生畏。全科医生认为EDA不适用于每个患者。他们认为需要学习曲线，并且需要时间投资。EDA被认为是值得信赖的，因为它们是由可靠的来源提供的。
结论：这项研究表明，通过支持实际的共同决策和增强患者的参与，EDA可以成为初级保健的有用工具。图形方法和清晰的表示帮助患者更好地理解他们的选择。为了克服健康素养和全科医生态度等障碍，仍然需要努力使EDAs变得可访问，通过使用简单的语言，尽可能直观和包容，统一设计,快速访问和培训。
背景：研究方案于2019年10月31日由UZ/KULeuven（比利时）批准，参考号为MP011977。
方法：我们应用了定性用户测试设计来评估全科医生和患者的用户体验。我们翻译了五个与初级保健相关的EDA，并观察了11名全科医生与患者使用EDA时的临床遭遇。我们在咨询后对每位患者进行了半结构化访谈，并在多次咨询后对每位全科医生进行了大声思考访谈。我们使用定性分析指南(QUAGOL)进行数据分析。
结果：对31次临床接触的直接观察和用户测试分析显示了总体积极的体验。EDA更好地参与决策，并为患者和临床医生带来有意义的见解。设计及其互动，多层结构使工具令人愉快和组织良好。困难的术语，规模和数量阻碍了对某些信息的理解，有时被认为过于专业化甚至令人生畏。全科医生认为EDA不适用于每个患者。他们认为需要学习曲线，并且需要时间投资。EDA被认为是值得信赖的，因为它们是由可靠的来源提供的。
结论：这项研究表明，通过支持实际的共同决策和增强患者的参与，EDA可以成为初级保健的有用工具。图形方法和清晰的表示帮助患者更好地理解他们的选择。为了克服健康素养和全科医生态度等障碍，仍然需要努力使EDAs变得可访问，通过使用简单的语言，尽可能直观和包容，统一设计,快速访问和培训。
背景：研究方案于2019年10月31日由UZ/KULeuven（比利时）批准，参考号为MP011977。
