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Artificial intelligence promotes shared decision-making through recommending tests to febrile pediatric outpatients

World Journal of Emergency Medicine 2023年第2期14卷 106-111页

作者： Wei-hua Li Bin Dong Han-song Wang Jia-jun Yuan Han Qian Ling-ling Zheng Xu-lin Lin Zhao Wang Shi-jian Liu Bo-tao Ning Dan Tian Lie-bin Zhao Pediatric AI Clinical Application and Research Center Shanghai Children’s Medical CenterShanghai 200127China Shanghai Engineering Research Center of Intelligence Pediatrics(SERCIP) Shanghai 200127China Child Health Advocacy Institute China Hospital Development Institute of Shanghai Jiao Tong UniversityShanghai 200127China Pediatric Intensive Care Unit Shanghai Children’s Medical CenterShanghai Jiao Tong University School of MedicineShanghai 200127China Hangzhou YITU Healthcare Technology Co.Ltd. Hangzhou 310000China

BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with ***:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient *** calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s *** patients were divided into the rejection and acceptance *** we analyzed the rejected examination items in order to obtain the corresponding ***:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient *** recommended examinations given by Xiaoyi for 10,636(89.6%)patients were *** average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.

关键词： Artificial intelligence Pediatric outpatient Medical examinations shared decision-making

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Older Patients’ Involvement in shared decision-making—A Systematic Review

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Open Journal of Nursing 2016年第3期6卷 170-185页

作者： Anne Lise Holm Astrid Karin Berland Elisabeth Severinsson Department of Health Science Stord/Haugesund University College Stord Norway Centre for Women’s Family and Child Health Faculty of Health Sciences University College of Southeast Norway Kongsberg Norway

shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

关键词： Involvement Patient shared decision-making Systematic Review

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The concept of narrative evidence-based medicine and shared decision-making in traditional Chinese medical practice

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TMR Integrative Medicine 2018年第3期2卷 99-104页

作者： Wei Mu Hong-Cai Shang Xu-Fang Gu Li Zhang Yan-Fen Li Jie Li Rui-Hua Wang Yu-Hong Huang Bao-He Wang Department of Clinical Pharmacology Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China The second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine Cardiovascular Department Tianjin China Key Laboratory of Traditional Chinese Medical Sciences of Dongzhimen Hospital of Beijing University of Chinese Medicine Beijing China

For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.

关键词： Narrative evidence-based medicine Clinical practice of TCM shared decision-making decision aids

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Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado,United States:Real-world data

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World Journal of Rheumatology 2020年第1期10卷 1-10页

作者： Rovshan Ismailov Steven Simoens Zaytuna Khasanova Complex Mechanisms of Disease Aging and Trauma Research FoundationDenverCO 80246United States Department of Pharmaceutical and Pharmacological Sciences KU LeuvenLeuven 3000Belgium

BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic *** To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in *** developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous *** There were a total of 49(2.5%)rheumatology patients who responded to our *** reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared *** survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or *** improvement in scores after reading our educational materials was statistically significant for biosimilars and shared *** Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was *** educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.

关键词： Patients Biosimilars shared decision-making Education Survey Awareness

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Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

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World Journal of Emergency Medicine 2023年第5期14卷 380-385页

作者： Shu Li Jing Xie Ziyi Chen Jie Yan Yuliang Zhao Yali Cong Bin Zhao Hua Zhang Hongxia Ge Qingbian Ma Ning Shen Department of Emergency Medicine Peking University Third HospitalBeijing 100191China Department of Infectious Diseases State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical SciencesBeijing 100730China Department of Neurology the First Affi liated HospitalSun Yat-sen UniversityGuangzhou 510080China Department of Obstetrics and Gynecology Peking University First HospitalBeijing 100034China Department of Nephrology West China HospitalWest China School of MedicineChengdu 610041China Institute of Medical Humanities School of Foundational EducationPeking University Health Science CenterBeijing 100191China Department of Emergency Medicine Beijing Jishuitan HospitalFourth Medical College of Peking UniversityBeijing 100035China Clinical Epidemiology Research Center Peking University Third HospitalBeijing 100191China Department of Pulmonary and Critical Care Medicine Peking University Third HospitalBeijing 100191China

BACKGROUND:shared decision-making(SDM)has broad application in *** published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical *** study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in ***:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency *** were identified based on their expertise in medicine,law,administration,medical education,or patient *** individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of ***:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was *** acceptable Kendall’s W coefficient was ***:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

关键词： shared decision-making Life-sustaining treatment Emergency Checklist

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Conditions for autonomous choice： a qualitative study of older adults＇ experience of decision-making in TAVR

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Journal of Geriatric Cardiology 2017年第1期14卷 42-48页

作者： Elisabeth Skaar Anette Hylen Ranhoff Jan Erik Nordrehaug Daniel E Forman Margrethe Aase Schaufel Department of Heart Disease Haukeland University Hospital Bergen Norway Department of Clinical Science University of Bergen Bergen Norway Kavli Research Centre for Geriatrics and Dementia Haraldsplass Deaconess Hospital Bergen Norway University of Pittsburgh Medical Center VA Pittsburgh Healthcare System Pittsburgh USA Research Unit for General Practice Uni Research Health Bergen Norway Department of Thoracic Medicine Haukeland University Hospital Bergen Norway

Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.

关键词： Aortic stenosis Older adults Patient-centered care shared decision-making Trans-catheter aortic valve replacement

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Development of a decision Aid for Family Surrogate decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

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Chinese Medical Sciences Journal 2024年第2期39卷 91-101页

作者： Miao Zheng Yong-Hui Zhang Ying Cao Chang-Lin Yin Li-Hua Wang Department of Outpatient First Affiliated Hospital of Army Medical UniversityChongqing 400038China Department of Critical Care Medicine First Affiliated Hospital of Army Medical UniversityChongqing 400038China Administration Office First Affiliated Hospital of Army Medical UniversityChongqing 400038China

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)*** study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with *** Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of *** The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing *** decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence *** decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge ***-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to *** DA was drafted into a web-based phototype using the elements of *** platform could guide users in their preparation of decision-making through a sequential four-step process:identifying

关键词： decision aids renal replacement therapy intensive care units shared decision-making user-centered design surrogate

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Patient-centered care through internal and external participation in medical rehabilitation

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Health 2013年第6期5卷 48-55页

作者： Mirjam Korner Department of Medical Psychology and Medical Sociology University of FreiburgFreiburgGermany

Patient-centeredness is one of the most important quality and outcome criteria in health care. Health care organizations are continually searching for approaches that will enable them to establish sustainable patient-centeredness in their daily practice. Existing approaches frequently focus on interaction between patient and health care professional (external participation). However, this is often not sufficient;other elements, such as good teamwork among the health care professionals (internal participation), are also essential. The model of integrated patient-centeredness differentiates between these two participations forms, both of which are explored from a patient and health care professional perspective in our study. The aim of the study was to confirm the model from the viewpoint of staff and patients. To this end we conducted a multi-center cross-sectional study consisting of a patient and staff survey to assess internal and external participation and patient-centeredness. A total of 15 rehabilitation clinics were involved, with 272 staff members and 536 patients included in the final analysis. Although evaluation was positive (mainly slightly above the middle of the scale), there was potential for improvement for both types of participation. Internal and external rating differed between patients and health care staff, with the first group assessing internal significantly better and external lower than the second group. The low to middle correlation of both types, as well as the correlation and regression with patient-centeredness, confirmed the model of integrated patient-centeredness. The model underlines the importance of both participation forms for patient-centeredness, as well as their interdependence. Further studies are needed in order to verify the impact of internal and external participation, as well as that of further possible dimensions of patient-centeredness, on clinical and functional outcome criteria.

关键词： Patient-Centeredness Participation Rehabilitation shared decision-making Teamwork

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医患个体特征影响共享决策的心理路径：基于内隐原型视角

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心理学 2023年第10期

作者：袁香儿赵睿雯朱冬青

医患共享决策对医患双方均可产生积极效果，但已有研究多限于综述其影响因素而未探究背后的心理路径。文章从内隐原型的理论视角，提出医患对自身和对对方的共享决策内隐原型，并据此阐明医患个体特征影响共享决策的内隐原型心理路径(... 详细信息

医患共享决策对医患双方均可产生积极效果，但已有研究多限于综述其影响因素而未探究背后的心理路径。文章从内隐原型的理论视角，提出医患对自身和对对方的共享决策内隐原型，并据此阐明医患个体特征影响共享决策的内隐原型心理路径(医患心理特征→医患心理状态→医患共享决策内隐原型→医患共享决策行为)。以此为划分标准，文章建构医患共享决策的内隐原型研究框架，整理总结以往医患共享决策影响因素的研究，并提出发掘影响共享决策的医患个体特征、探究医患个体特征可能影响的心理状态、检验医患共享决策内隐原型的作用、关注医患个体特征发挥作用的调节变量等潜在的研究主题。

关键词：医患共享决策内隐原型医患权势不平衡医患沟通 shared decision-making implicit prototype doctor-patient power imbalance doctor-patient communication

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安宁疗护医患共同决策的临床实践及对策

安宁疗护医患共同决策的临床实践及对策

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中国老年学和老年医学学会2021年学术大会--积极应对...

作者：胡宗萍吕登智陈鑫李辉荣陈茹怡彭静闻重庆市第十三人民医院医养结合部

医患共同决策（SDM）的目的是向患者提供信息,便于患者与医生一起自主自由地决定治疗方案而不会受到他人的干扰、强迫或胁迫。在安宁疗护中,医生应同患者或患者家属充分沟通多种疗护选择的利弊,基于患者经济背景、社会价值、个人偏好等... 详细信息

医患共同决策（SDM）的目的是向患者提供信息,便于患者与医生一起自主自由地决定治疗方案而不会受到他人的干扰、强迫或胁迫。在安宁疗护中,医生应同患者或患者家属充分沟通多种疗护选择的利弊,基于患者经济背景、社会价值、个人偏好等多方面因素做出对患者疗护最有利的共同决策。本文分析医患共同决策在国内外的研究现状,根据医患共同决策原则,探讨医患共同决策在我国临床实践现状,进一步指出安宁疗护医患共同决策实践的障碍,从而提出合理的对策。分析发现,安宁疗护医患共同决策在我国执行难的主要障碍是观念老旧、责任划分困难、信息不对称,同时提出通过转变观念、使用决策辅助工具、实施预立遗嘱、尊重患者意愿等措施提高安宁疗护医患共同决策的质量。本文研究对于改善安宁疗护医患共同决策过程、优化决策方式、提高安宁疗护效果具有积极的作用。

关键词：安宁疗护共同决策 SDM shared decision-making

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