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Abstract：
Background: Shared decision making (SDM) is the process by which patients and clinicians exchange information and preferences to come to joint healthcare decisions. Clinical dashboards can support SDM by collecting, distilling, and presenting critical information, such as patient-reported outcomes (PROs), to be shared at points of care and in between appointments. We describe the implementation strategies and outcomes of a multistakeholder collaborative process known as \"co-design\" to develop a PRO-informed clinical dashboard to support SDM for patients with advanced cancer or chronic kidney disease (CKD). Methods: Across 14 sessions, two multidisciplinary teams comprising patients, care partners, clinicians, and other stakeholders iteratively co-designed an SDM dashboard for either advanced cancer (N = 25) or CKD (N = 24). Eligible patients, care partners, and frontline clinicians were identified by six physician champions. The co-design process included four key steps: (1) define \"the problem\", (2) establish context of use, (3) build a consensus on design, and (4) define and test specifications. We also evaluated our success in implementing the co-design strategy using measures of fidelity, acceptability, adoption, feasibility, and effectiveness which were collected throughout the process. Results: Mean (M) scores across implementation measures of the co-design process were high, including observer-rated fidelity and adoption of co-design practices (M = 19.1 on a 7-21 scale, N = 36 ratings across 9 sessions), as well as acceptability based on the perceived degree of SDM that occurred during the co-design process (M = 10.4 on a 0 to 12 adapted collaboRATE scale). Capturing the feasibility and adoption of convening multistakeholder co-design teams, min-max normalized scores (ranging from 0 to 1) of stakeholder representation demonstrated that, on average, 95% of stakeholder types were represented for cancer sessions (M = 0.95) and 85% for CKD sessions (M = 0.85). The co-design process was rated as either \"fully\" or \"partially\" effective by 100% of respondents, in creating a dashboard that met its intended objective. Conclusions: A co-design process was successfully implemented to develop SDM clinical dashboards for advanced cancer and CKD care. We discuss key strategies and learnings from this process that may aid others in the development and uptake of patient-centered healthcare innovations.
摘要：
背景：共享决策（SDM）是患者和临床医生交换信息和偏好以共同做出医疗决策的过程。临床仪表板可以通过收集、蒸馏，并提供关键信息，例如患者报告的结果(PRO)，在护理点和预约之间共享。我们描述了被称为“共同设计”的多利益相关方协作过程的实施策略和结果，以开发PRO知情的临床仪表板，以支持晚期癌症或慢性肾脏疾病（CKD）患者的SDM。方法：在14个疗程中，两个由患者组成的多学科小组，护理伙伴，临床医生,和其他利益相关者迭代地共同设计了针对晚期癌症(N=25)或CKD(N=24)的SDM仪表板。符合条件的患者，护理伙伴，一线临床医生由六名医生冠军确定。协同设计过程包括四个关键步骤：（1）定义“问题”，(2)建立使用环境，（3）在设计上建立共识，和(4)定义和测试规范。我们还评估了我们在实施共同设计策略方面的成功，可接受性,收养,可行性,以及在整个过程中收集的有效性。结果：共同设计过程实施措施的平均(M)得分很高，包括观察者评级的保真度和采用共同设计实践(M=19.1，在7-21量表上，N=9个会议的36个评级)，以及基于在共同设计过程中发生的SDM感知程度的可接受性(在0到12个自适应的collabRATE量表上,M=10.4)。捕捉召集多利益相关方共同设计团队的可行性和采用，利益相关者代表的最小-最大归一化分数(范围从0到1)表明，平均而言,95%的利益相关者类型代表癌症疗程（M=0.95），85%代表CKD疗程（M=0.85）。100％的受访者将共同设计过程评为“完全”或“部分”有效，创建一个符合其预期目标的仪表板。结论：成功实施了共同设计过程，以开发用于晚期癌症和CKD护理的SDM临床仪表板。我们讨论了从这一过程中获得的关键策略和经验，这些策略和经验可能会帮助其他人开发和吸收以患者为中心的医疗保健创新。
