Evaluation of an observer training curriculum using the Multifocal Approach to the sharing In the Shared Decision Making (MAPPIN’SDM) - An instrument for evaluating shared decision making in patient consultations

Abstract

<p>Background: In recent years, the concept of shared decision making (SDM) has gained support in the medical community. SDM has also been supported by legal documents as the best model of medical decision making. In light of this, development of instruments measuring the degree of patient involvement in clinical consultations has increased. MAPPIN’SDM is the first instrument to be validated and translated to Norwegian. While observation based evaluation is highly dependable on the competency of observers, empirical studies on ideal models for rater training is lacking. This study aims to evaluate and adjust the Norwegian rater training curriculum for MAPPIN’SDM. <p>Method: In this feasibility and validation study, a standardized 4 days rater-training program was applied to a group of three trainees with no previous experience with the instrument. Ratings performed on videotaped clinical consultations relevant for SDM were used to calculate inter-rater reliability using T-coefficients (modified Cohen’s kappa) and percentage agreement (%A). <p>Results: Inter-rater reliabilities during the training were moderate to strong on average over the 11 items of each of three observer-scales (Tmean: MAPPINdoctor = .62, range= .41-.91; MAPPINpatient = .66, range= .36-1.0; MAPPINdyad= .59, range= .30 - .91). All trainees achieved accurate compared to the reference standard with regard to both sensitivity (sensitivitymean: MAPPINdoctor= 90, range= 56 - 100%; MAPPINpatient= 83, range= 38 - 100%; MAPPINdyad= 92, range: 64 - 100%) and specificity (specificitymean: MAPPINdoctor= 83, range= 56 - 97%; MAPPINpatient= 81, range: 33 - 100%; MAPPINdyad= 90, range: 81 - 100%). The results also show that the new curriculum is capable to develop high to excellent rater competency within a 4 day rater-training program. <p>Conclusion: The observer training curriculum corresponding to the MAPPIN’SDM observer scales proves feasible and capable to develop high observer competencies. In addition, the study reveals a need for evaluated trainings necessary for making use of observation-based communication assessment scales in general.