A skills network approach to physicians’ competence in shared decision making

Abstract

Background: Measurement of physicians' competence in shared decision making (SDM) remains challenging with frequent disagreement between assessment methods. Objective: To conceptualize and measure physicians' SDM competence as an organized network of behavioural skills and to determine whether processing patient-reported data according to this model can be used to predict observer-rated competence. Design: Secondary analysis of an observational study. Setting and participants: Primary and specialty outpatient care physicians and consecutively recruited adult patients with a chronic condition who faced a treatment decision with multiple acceptable choices. Measures: Network parameters constructed from patients' assessment of physicians' SDM skills as measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and observer-rated SDM competence of physicians measured by three widely used observer-rated instruments. Results: 29 physicians (12 female, 17 male; mean age 50.3 years) recruited 310 patients (59.4% female, 40.6% male; mean age 54.0 years) facing a decision mainly regarding type 2 diabetes (36.4%), chronic back pain (32.8%) or depressive disorder (26.8%). Although most investigated skills were interrelated, elicitation of the patient's treatment preferences showed the strongest associations with the other skills. Network parameters of this skill were also decisive in predicting observer-rated competence. Correlation between predicted competence scores and observer-rated measurements ranged from 0.710 to 0.785. Conclusions: Conceptualizing physicians' SDM competence as a network of interacting skills enables the measurement of observer-rated competence using patientreported data. In addition to theoretical implications for defining and training medical

Application of the skills network approach to measure physician competence in shared decision making based on self-assessment

“…The design of the present study was based on a previous investigation [ 13 ]. We re-analyzed data from a study on measuring SDM, collected between August 2009 and September 2010 in Hamburg, Germany [ 14 ].…”

“…This measure requires physicians to rate the degree to which they showed nine behaviors in the consultation using a six-step Likert-type scale ranging from zero to five. The behaviors captured by the SDM-Q-Doc correspond to key SDM skills: focusing the decision, sharing the decision, presenting options, informing on options, supporting comprehension, eliciting preferences, deliberating the decision, selecting an option, and planning actions [ 13 , 15 ].…”

“…Conceptual clarity is indispensable for the measurement of latent constructs [ 12 ]. From a competence-focused perspective, SDM competence can be defined as the physician’s ability to use specific behavioral skills in a way which supports building a consensus with the patient regarding the favored treatment among multiple viable options in accordance with the patient’s preferences and values [ 13 ]. According to this approach, SDM competence requires physicians to organize a defined set of behavioral skills into a certain pattern or network to make a patient-centered decision in the medical consultation more likely.…”

“…In a recent study, we found that modelling SDM competence as a network of skills can be used to predict physicians’ observer-rated SDM competence [ 13 ]. In that study, patients rated the degree to which certain SDM-related skills were shown by the physicians in their routine medical consultations.…”

Using DEMATEL Technique to Identify the Key Success Factors of Shared Decision-Making Based on Influential Network Relationship Perspective

“…Kheirkhah et al [36] applied the SDM-Q-Doc version to explore the psychological predictors of SDM between residents and patients. Based on the SDM-Q-9, Kriston et al [37] formulated a network model to assess the competency of clinicians in applying SDM and predicting outcomes. Song and Sandra [38] used a 10-item IDM scale to investigate the experience of elderly patients in postdialysis decision-making.…”