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Development of a Tool to Measure the Dyadic Process of Shared Decision Making in Young Children: The Making Decisions
Douglas J Opel1, Elsa Ayala1, Heather Spielvogle1
1Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA.
Insights
Researchers developed a new tool to measure shared decision making (SDM) between clinicians and parents in pediatrics. This preliminary instrument captures both perspectives, addressing a gap in pediatric healthcare measurement.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Patient-Centered Care
Background:
- Shared decision making (SDM) is crucial in healthcare, yet tools for measuring it in pediatrics are lacking.
- Existing SDM measures do not capture the dyadic nature of clinician-patient interactions from multiple viewpoints.
- There is a need for a validated instrument to assess SDM in pediatric settings from both clinician and parent perspectives.
Purpose of the Study:
- To develop and preliminarily validate a novel tool for measuring shared decision making (SDM) in pediatrics.
- To create an instrument that captures SDM from the distinct perspectives of both clinicians and parents of young children.
- To address the gap in pediatric measurement tools for the inherently dyadic process of SDM.
Main Methods:
- A stepwise iterative approach was used, including de novo item generation and adaptation of existing instruments.
- Items were refined through expert review (SDM experts, parents) and pre-testing with clinicians and parents at two children's hospitals.
- Face validity, usability, and item understandability were assessed through iterative revisions with sequential cohorts.
Main Results:
- An initial pool of 28 items was reduced to a final 12-item tool for both clinician and parent versions.
- The preliminary tool underwent iterative refinement and pre-testing with 31 clinicians and 30 parents across three cohorts.
- The final tool demonstrated usability and included an optional free-text item for further qualitative insights.
Conclusions:
- A usable preliminary tool for measuring the dyadic process of shared decision making (SDM) in pediatrics has been successfully developed.
- This tool represents a significant advancement in measuring SDM from multiple perspectives in pediatric care.
- Further research is warranted to establish the psychometric properties of this novel SDM measurement instrument.
Abstract:
BackgroundIncorporating clinician and patient perspectives in the measurement of shared decision making (SDM) is aligned with SDM's inherently dyadic nature. There are no tools measuring SDM in pediatrics from multiple perspectives. The objective of this study was to develop a tool to measure SDM from the perspectives of both clinicians and parents of young children.DesignWe used a stepwise iterative approach to tool development beginning with de novo item generation and followed by augmentation of the item pool by adapting items from existing instruments. After the study team removed redundant items, 3 parents and 3 SDM experts rated the remaining items for their ability to capture SDM in pediatrics; items with the lowest mean ratings were removed. To assess the preliminary tool's face validity, usability, and item understandability, we pretested it, revising it iteratively, with sequential cohorts of English-speaking parents and clinicians from 2 US children's hospitals.ResultsWe generated an initial list of 28 items for the parent and clinician versions of the tool, which we reduced to 20 items after preliminary review. After review by parents and SDM experts, we cut 9 items and added 1 additional item for a total of 12 items. We pretested the preliminary tool with 31 clinicians and 30 parents across 3 sequential cohorts. The final tool contained 12 items and an optional free-text item.LimitationsAll participants were English speaking, limiting its generalizability.ConclusionsWe have developed a usable preliminary tool for measuring the dyadic process of SDM in pediatrics.ImplicationsThis tool represents an important first step toward addressing the measurement of SDM in pediatrics from multiple perspectives.HighlightsIn this study, we have developed the first shared decision making (SDM) tool specifically for use with parents of young children.Although further study is needed to determine the psychometric properties of this tool, it has the potential to address an important gap in our ability to measure SDM in pediatrics from multiple perspectives.
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