Characteristics of participating physicians.

Several approaches to and definitions of ‘shared decision making’ (SDM) exist, which makes measurement challenging. Recently, a skills network approach was proposed, which conceptualizes SDM competence as an organized network of interacting SDM skills. With this approach, it was possible to accurately predict observer-rated SDM competence of physicians from the patients’ assessments of the physician’s SDM skills. The aim of this study was to assess whether using the skills network approach allows to predict observer-rated SDM competence of physicians from their self-reported SDM skills. We conducted a secondary data analysis of an observational study, in which outpatient care physicians rated their use of SDM skills with the physician version of the 9-item Shared Decision Making Questionnaire (SDM-Q-Doc) during consultations with chronically ill adult patients. Based on the estimated association of each skill with all other skills, an SDM skills network for each physician was constructed. Network parameters were used to predict observer-rated SDM competence, which was determined from audio-recorded consultations using three widely used measures (OPTION-12, OPTION-5, Four Habits Coding Scheme). In our study, 28 physicians rated consultations with 308 patients. The skill ‘deliberating the decision’ was central in the population skills network averaged across physicians. The correlation between parameters of the skills networks and observer-rated competence ranged from 0.65 to 0.82 across analyses. The use and connectedness of the skill ‘eliciting treatment preference of the patient’ showed the strongest unique association with observer-rated competence. Thus, we found evidence that processing SDM skill ratings from the physicians’ perspective according to the skills network approach offers new theoretically and empirically grounded opportunities for the assessment of SDM competence. A feasible and robust measurement of SDM competence is essential for research on SDM and can be applied for evaluating SDM competence during medical education, for training evaluation, and for quality management purposes. [A plain language summary of the study is available at https://osf.io/3wy4v.]

目前针对“共同决策（shared decision making, SDM）”存在多种研究路径与定义，这为其量化测评带来了挑战。近期有研究提出了技能网络研究路径，将SDM能力界定为一组相互协同、彼此关联的SDM技能所构成的结构化网络。借助该研究路径，研究者可通过患者对医师SDM技能的评价，精准预测经观察者评分的医师SDM能力。本研究旨在验证：采用技能网络研究路径，是否可通过医师自我报告的SDM技能评分，预测其经观察者评分的SDM能力。本研究对一项观察性研究的数据集进行了二次分析：该研究中，门诊医师在与成年慢性病患者的面诊过程中，通过9条目共同决策问卷（医师版，SDM-Q-Doc）自评其SDM技能的使用情况。基于各技能与其余所有技能的估计关联强度，研究者为每位医师构建了专属的SDM技能网络。以网络参数作为预测变量，对经观察者评分的医师SDM能力进行预测；该能力评分通过对录音面诊资料采用三项通用测评工具（OPTION-12、OPTION-5、Four Habits Coding Scheme）分析得到。本研究共纳入28位医师，其累计完成308例面诊的评分工作。在全体医师的平均群体技能网络中，“审议决策”技能处于核心地位。不同分析场景下，技能网络参数与观察者评分的SDM能力间的相关系数区间为0.65至0.82。“唤起患者治疗偏好”技能的使用程度及其关联强度，与观察者评分的SDM能力呈现出最强的独特关联。综上，本研究证实：基于技能网络研究路径，对医师视角的SDM技能评分进行分析，可为SDM能力测评提供兼具理论与实证依据的全新路径。可靠且稳健的SDM能力测评方法，是SDM相关研究的核心前提，同时可应用于医学教育中的SDM能力评估、培训效果评价以及质量管理工作。[本研究的通俗语言摘要可访问：https://osf.io/3wy4v.]