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Mandhana DM, Jacome CS, Ballard DI, Tesfai Y, Johnson SB, Gionfriddo MR, Espinoza Suarez NR, Perneth SA, Su L, Montori VM. Developing and validating the Unhurried Conversations Assessment Tool (UCAT). Patient Educ Couns 2024; 123:108237. [PMID: 38461793 DOI: 10.1016/j.pec.2024.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. METHODS In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. RESULTS UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). CONCLUSION UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. PRACTICE IMPLICATIONS UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, Villanova University, Villanova, PA, USA; Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Cristian Soto Jacome
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Norwalk Hospital, Department of Internal Medicine, Nuvance Health, Norwalk, CT, USA
| | - Dawna I Ballard
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Yohanna Tesfai
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Sarah B Johnson
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Division of Pharmaceutical, Administrative, and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nataly R Espinoza Suarez
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sandra Algarin Perneth
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lillian Su
- Division of Cardiovascular Intensive Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor M Montori
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
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Singh Ospina N, Patel Chavez C, Godinez Leiva E, Bagautdinova D, Hidalgo J, Hartasanchez S, Algarin Perneth S, Barb D, Danan D, Dziegielewski P, Hughley B, Srihari A, Subbarayan S, Castro MR, Dean D, Morris J, Ryder M, Stan MN, Hargraves I, Bylund CL, Treise D, Montori VM, Brito JP. Clinician feedback using a shared decision-making tool for the evaluation of patients with thyroid nodules-an observational study. Endocrine 2024; 83:449-458. [PMID: 37695453 PMCID: PMC10999160 DOI: 10.1007/s12020-023-03519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND We pilot-tested an encounter conversation aid to support shared decision making (SDM) between patients with thyroid nodules and their clinicians. OBJECTIVE Characterize the clinician feedback after providing care to patients with thyroid nodules using a tool to promote SDM conversations during the clinical encounter, and evaluate how clinicians used the tool during the visit. METHODS Mixed method study in two academic centers in the U.S., including adult patients presenting for evaluation of thyroid nodules and their clinicians. We thematically analyzed interviews with clinicians after they used the SDM tool in at least three visits to characterize their feedback. Additionally, investigators evaluated visits recordings to determine the extent to which clinicians engaged patients in the decision-making process (OPTION score, scale 0 to 100, higher levels indicating higher involvement), the tool's components used (fidelity), and encounter duration. Using a post-visit survey, we evaluated the extent to which clinicians felt the tool was easy to use, helpful, and supportive of the patient-clinician collaboration. RESULTS Thirteen clinicians participated in the study and used the SDM tool in the care of 53 patients. Clinicians thought the tool was well-organized and beneficial to patients and clinicians. Clinicians noticed a change in their routine with the use of the conversation aid and suggested it needed to be more flexible to better support varying conversations. The median OPTION score was 34, the fidelity of use 75%, and the median visit duration 17 min. In most encounters, clinicians agreed or strongly agreed the tool was easy to use (86%), helpful (65%), and supported collaboration (62%). CONCLUSION Clinicians were able to use a SDM tool in the care of patients with thyroid nodules. Although they wished it were more flexible, they found on the whole that its use in the clinical encounter was beneficial to patients and clinicians.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - Chandani Patel Chavez
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Eddison Godinez Leiva
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Hartasanchez
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Sandra Algarin Perneth
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Diana Barb
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | | | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, FL, USA
| | - Ashok Srihari
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sreevidya Subbarayan
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Diana Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - John Morris
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mabel Ryder
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Marius N Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
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