Development of PRIDe: a tool to assess physicians' preference of role in clinical decision making

Factors influencing the degree of participation in surgical decision-making among Chinese patients with prostate cancer: A qualitative research

Objective

There was increasingly demand of participation in surgical decision-making among Chinese patients with prostate cancer. However, due to the complex healthcare system and advanced care settings, it is quite challenging for the patients to gain sufficient support from the institute and the government. This research aimed to investigate the factors that impact the degree of participation in surgical decision-making among Chinese prostate cancer patients.

Methods

A phenomenological approach of qualitative research based on the results of semi-structured interviews was adopted, to explore the influencing factors which hinder the participation in surgical decision-making. Consolidated Criteria for Reporting Qualitative Research were utilized. Up to 160 post-operative patients who had undergone radical prostatectomy along with 68 medical and nursing staffs, were purposively recruited in this research. This retrospective study was carried out from September 2018 to August 2019. After recording and transcribing the interviews, the interview materials were evaluated via the Colaizzi's seven step approach and the NVivo Version 10 software to analyze the interview content.

Results

According to the analysis and summary of the interviews, there were three factors affecting the degree of participation in surgical decision-making. Firstly, insufficient information was provided by medical and nursing staffs because of their lack of time, proper communication skills, and career experience, as well as difficulties in the development of patient decision aid and inconsistent resource availability. Secondly, the cognitive level of decision-making among patients was relatively low due to poor psychological endurance, insufficient amount of education, senility, and less knowledge and information demand. Ultimately, decisions were constantly made by family members with/without patients.

Conclusions

The degree of participation of Chinese prostate cancer patients in the surgical decision-making had much space for improvement.

The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice

OBJECTIVES

To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice.

METHODS

incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance.

RESULTS

The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations.

CONCLUSIONS

incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice.

PRACTICE IMPLICATIONS

incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.

Face-to-face communication between patients and family physicians in Canada: A scoping review

OBJECTIVE

Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada.

METHODS

Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes.

RESULTS

Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools.

CONCLUSION

Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care.

PRACTICE IMPLICATIONS

Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.

Threats to validity in the use and interpretation of script concordance test scores

CONTEXT

Recent reviews have claimed that the script concordance test (SCT) methodology generally produces reliable and valid assessments of clinical reasoning and that the SCT may soon be suitable for high-stakes testing.

OBJECTIVES

This study is intended to describe three major threats to the validity of the SCT not yet considered in prior research and to illustrate the severity of these threats.

METHODS

We conducted a review of SCT reports available through the Web of Science database. Additionally, we reanalysed scores from a previously published SCT administration to explore issues related to standard SCT scoring practice.

RESULTS

Firstly, the predominant method for aggregate and partial credit scoring of SCTs introduces logical inconsistencies in the scoring key. Secondly, our literature review shows that SCT reliability studies have generally ignored inter-panel, inter-panellist and test-retest measurement error. Instead, studies have focused on observed levels of coefficient alpha, which is neither an informative index of internal structure nor a comprehensive index of reliability for SCT scores. As such, claims that SCT scores show acceptable reliability are premature. Finally, SCT criteria for item inclusion, in concert with a statistical artefact of the SCT format, cause anchors at the extremes of the scale to have less expected credit than anchors near or at the midpoint. Consequently, SCT scores are likely to reflect construct-irrelevant differences in examinees' response styles. This makes the test susceptible to bias against candidates who endorse extreme scale anchors more readily; it also makes two construct-irrelevant test taking strategies extremely effective. In our reanalysis, we found that examinees could drastically increase their scores by never endorsing extreme scale points. Furthermore, examinees who simply endorsed the scale midpoint for every item would still have outperformed most examinees who used the scale as it is intended.

CONCLUSIONS

Given the severity of these threats, we conclude that aggregate scoring of SCTs cannot be recommended. Recommendations for revisions of SCT methodology are discussed.