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Identifying decisions in optometry: A validation study of the decision identification and classification taxonomy for
Vibeke Sundling1, Hege Anita Stene2, Hilde Eide3
1National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway; Science Center Health and Technology, Faculty of Health and Social Sciences, University of University of South-Eastern Norway, Drammen, Norway.
Objective:
The aim of this study was to assess the validity and reliability of the Decision Identification and Classification Taxonomy for Use in Medicine (DICTUM) applied to optometry, to compare decisions in medical and optometric consultations, and to describe decisions in optometry.
Methods:
The study had a cross-sectional design. Data was collected from January to August 2016. Forty video-recorded patient-optometrist consultations were analysed. Clinical decisions were categorised according to DICTUM by two independent coders.
Results:
The framework was applied without modification. The inter-rater reliability was moderate, Cohen's kappa 0.57. The mean duration of the consultations was 41 (±9) minutes. In all, 891 clinical decisions were identified, mean 22 (±13) per consultation. Types of decisions were significantly different between optometric and medical consultations (chi-square, p < 0.001). More frequently, optometrists conveyed interpreted test results (27.6% vs 16.7%) and gave advice (23.6% vs 8%), while doctors defined the problem (30.4% vs 24.6%) and decided on treatment (17.8% vs 13.4%).
Conclusion:
DICTUM is applicable to optometry encounters and may provide valuable insight to different health care settings.
Practice Implications:
Descriptive studiesofdecisions in patient-provider consultations is a first step for normative and prescriptive exploration of decision-making processes in health care.
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