127 Developing sensitizing items to detect shared decision making: results from an international delphi study
Abstract
Background Shared decision making (SDM) is increasingly promoted in policy and practice, yet it remains difficult to determine from recorded encounters whether SDM actually occurred. Existing observer instruments often capture efforts to involve patients rather than the underlying collaborative deliberation. Drawing on Dewey’s Theory of Inquiry, the Purposeful SDM model, review of the literature, and observation of recorded encounters, we developed 20 theory-informed sensitizing items, grouped into five categories (Noticing, Formulating, Trying Out, Forming a Conclusion, Enabling Actions), to help observers judge whether SDM took place. We used a Delphi process to examine the face validity and perceived usefulness of these items. Methods We conducted a two-round, web-based Delphi study with international SDM researchers identified through prior publications, professional networks, and invitations at ISDM 2022 and via the International SDM Society. Eligible panelists had experience using observer-based SDM instruments or routinely analyzing clinical encounters. In each round, participants rated whether each item (1) describes actions that occur in clinical encounters, (2) would be recognizable if present, (3) increases the likelihood that SDM occurred, and (4) would help researchers determine whether patients and clinicians worked together to address the patient’s problem. Consensus on item suitability was defined a priori as ≥70% agreement on the fourth statement. Results Twenty-four experts completed round 1 and twenty-one completed round 2. In round 1, 14 of 20 items met the consensus threshold. The remaining six items were clarified based on qualitative feedback and re-evaluated in round 2. Of these, four additional items were endorsed, one was judged unsuitable for inclusion, and one again failed to reach consensus. In total, 18 items spanning all five categories were retained as useful sensitizers for recognizing when SDM is likely to have occurred in recorded encounters. Discussion This Delphi process yielded a refined set of 18 theory-grounded sensitizing items that can guide observers in making a global judgment about whether SDM occurred across diverse clinical contexts. These items form the basis of SDMo, a novel observer-based measure focused on the occurrence of collaborative deliberation rather than on specific communication behaviors. Future work will prototype SDMo with users and evaluate its feasibility, validity, and responsiveness in real-world practice.
Authors 11
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Affiliation as printed
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Affiliation as printed
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Mayo Clinic · Leiden University Medical Center
Affiliation as printed
Health Campus The Hague, dept of Public Health and Primary Care, Leiden University Medical Center
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation as printed
Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minnesota, USA