An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach.
Wynne Callon, Mary Catherine Beach, Anne R Links and 2 others
PMID 29550295WHAT IT FOUND
Emotional support, understandable explanations, and recommendation talk were added to a shared decision-making framework from 55 pediatric surgical consultations.
Clinicians gave recommendations in all but one visit and did not actively check parent understanding.
Key findings
01The bottom-up analysis of real consultations added three domains not emphasized in existing shared decision-making coding systems: understandability, recommendation talk, and emotional environment.
02Clinicians gave one or more recommendations in all but one visit.
03No clinician actively checked parent understanding in the coded dialogues.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The framework was built from 55 initial consultation visits for pediatric sleep-disordered breathing at 3 sites, so it may not capture other decision settings or adult patients. It is descriptive and does not produce an overall score or test which behaviors improve shared decision-making or patient outcomes. Reliability is preliminary: only 14 visits were double-coded, and agreement for present/absent codes was as low as 50%. Most clinicians were surgeons; only 1 nurse practitioner participated, so nurse-specific use is not established. No outcomes such as parent knowledge, satisfaction, or decision quality were analyzed here.
Declared interests
The data came from an NIH-funded parent study (K08HS022932, PI Boss); the authors reported no relevant financial conflicts of interest.
The easy way to misread this
Do not read the 89% coder agreement as evidence that this framework improves shared decision-making or patient outcomes. It is a descriptive coding system with preliminary reliability and no tested effect on decisions.