619 - Clinicians' Perceptions and Experiences with Collaborative Decision-Making

Publication Number: 619.4163

Hyeyoung Ryu, University of Washington, Seattle, WA, United States; Zixuan Xu, Seattle Children's, Seattle, WA, United States; Chelsea Ng, Seattle Children's, Seattle, WA, United States; Lily V. Jeffs, Seattle Children's, Redwood City, CA, United States; Ryan Hutson, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Jaime Snyder, University of Washington, Information School, Seattle, WA, United States; Wanda Pratt, University of Washington, Seattle, WA, United States; Cozumel Pruette, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Aaron Wightman, University of Washington School of Medicine, Seattle, WA, United States; Ari Pollack, University of Washington School of Medicine, Seattle, WA, United States

Background: Collaborative decision-making (CDM) aims to improve collaboration and communication in decision-making and ensure that care plans align with pediatric patients' values, preferences, and goals. It offers opportunities to improve patient and family engagement, patient self-efficacy, wellbeing, and outcomes yet it is rarely achieved in pediatric nephrology.

Objective: Our study sought to understand pediatric nephrologists' experiences and perspectives utilizing CDM and how they determine patients’ ability to meaningfully and appropriately engage in decision-making.

Design/Methods: We conducted interviews with 17 pediatric nephrologists at two academic children’s hospitals. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach. Four of the authors co-coded six transcripts using MAXQDA software and individually coded the remaining eleven transcripts. Intercoder reliability was assessed using Krippendorff’s alpha, which yielded a score of 0.82, indicating strong agreement among coders.

Results: Pediatric nephrologists aspired to engage in CDM by making information accessible, relatable, and reflective of the patient and their caregivers' values, while also ensuring that patients and their caregivers fully understand the information necessary for making informed decisions. They also saw themselves as responsible for assessing patients' readiness to participate in CDM, considering various factors, with age and developmental stage as essential elements (Figure 1). Clinicians identified two key barriers to engaging in effective CDM: (1) limited time in clinic visits and (2) the complexity of medical information. Due to the time constraints in clinic visits, clinicians found it challenging to engage in meaningful value elicitation. Additionally, the complexity of medical information made it challenging for clinicians to convey the information effectively and assess patient and caregiver comprehension.

Conclusion(s): Our findings indicate that clinicians desire to engage in CDM but are constrained by current barriers. This suggests opportunities for future tools to enhance how information is created and delivered prior to clinic visits. Additionally, we believe that understanding how clinicians assess patients' comprehension could help us create tools that enable patients to communicate their understanding more clearly, fostering more effective interactions with clinicians. Ultimately, enhancing communication and CDM by first developing and then leveraging these future tools could improve patient well-being, boost self-efficacy, and lead to better health outcomes.

Figure 1: Clinicians’ Perceived Roles in Facilitating Collaborative Decision-Making
The boxes on the left represent the three roles clinicians perceive themselves to have in facilitating collaborative decision-making. The bullet points beside each arrow detail what clinicians aim to explain or consider to effectively fulfill each role.