Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

Mette Kjer Kaltoft, Warwick Selby, Glenn Salkeld, Jesper Bo Nielsen, Jack Dowie

Publikation: Konferencebidrag uden forlag/tidsskriftKonferenceabstrakt til konferenceForskningpeer review

Abstract

Purpose:
To explore the feasibility and potential of a prescriptive, web-based, decomposable measure of decision quality (MyDecisionQuality (MDQ)); to assess and enhance patient-clinician decision concordance, thereby facilitating more transparent shared decision making and documentation of better informed consent.
Methods:
Data presented are from patient-clinician dyads in an Inflammatory Bowel Disease decision aid study: web (log, MDQ scores, patient comments), interviews (with patients), presentations of the MDQ and concordance measures. Matched sets of MDQ data (Weightings (W) and Ratings (R) of the 8 MDQ criteria (options, effects, importance, chances; trust, support, control, commitment) were elicited and fed back in decomposed formats, along with concordance measures (Mean Squared Difference (MSD), Mean Absolute Difference (MAD)). The Incremental Values of Perfect Ratings were calculated to quantify, document, and suggest how future dyadic decisions can be enhanced by criterion prioritisation. Associations between patient’s MDQ-W before, and MDQ-R after consultation with their clinician were analysed along with patient scores from the Satisfaction With Decision (SWD) instrument.
Results:
Patient’s online feedback quotes and face-to-face interviews suggested that the MDQ instrument prompted increased decision thought. The 8 MDQ criteria were interpreted as providing an acceptable decision quality instrument. Of the illustrative results for two dyads, the first displayed perfect concordance on both W and R for options and control, but otherwise a discordant W distribution. The other dyad showed more discordant W and R. The MSDs of W and R were .0275 and .0175 for the former patient and .0150 and .0025 for the latter. The MADs of W and R were .1250 and .1000 for the former and .1000 and .0250 for the latter. The patient’s MDQ scores were .886 and .954 with SWD scores of 1.0 and .8 respectively. (The correlation between MDQ and SWD instruments for the initial 29 patients was 0.70.)
Conclusion:
Proof of concept and method is presented in relation to the degree of concordance between patient and clinician using the dually-personalised decomposable MyDecisionQuality (MDQ) instrument. This has the potential to guide future work on optimising dyad-specific patient-clinician communication for shared decision making and informed consent.
OriginalsprogEngelsk
Publikationsdato8. jun. 2014
StatusUdgivet - 8. jun. 2014
Begivenhed15th Biennial European Meeting: Special Focus on Clinical Decision Making in the Era of Personalized Medicine - Antwerpen, Belgien
Varighed: 8. jun. 201410. jun. 2014
Konferencens nummer: 15

Konference

Konference15th Biennial European Meeting
Nummer15
Land/OmrådeBelgien
ByAntwerpen
Periode08/06/201410/06/2014

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