School of Journalism and Communication, Shanghai University, 149 Yanchang Drive, 1006 Xingjian Building, Shanghai, 200072, China.
Department of Preventive Medicine, Northwestern University, Chicago, IL, 60611, USA.
BMC Med Inform Decis Mak. 2022 Dec 7;22(1):323. doi: 10.1186/s12911-022-02058-3.
Clinical decision aids may support shared decision-making for screening mammography. To inform shared decision-making between patients and their providers, this study examines how patterns of using an EHR-integrated decision aid and accompanying verbal patient-provider communication predict decision-making satisfaction.
For 51 patient visits during which a mammography decision aid was used, linguistic characteristics of patient-provider verbal communication were extracted from transcribed audio recordings and system logs automatically captured uses of the decision aid. Surveys assessed patients' post-visit decisional satisfaction and its subcomponents. Linear mixed effects models assessed how patients' satisfaction with decision making was related to patterns of verbal communication and navigation of the decision aid.
The results indicate that providers' use of quantitative language during the encounter was positively associated with patients' overall satisfaction, feeling informed, and values clarity. Patients' question-asking was negatively associated with overall satisfaction, values clarity, and certainty perception. Where system use data indicated the dyad had cycled through the decision-making process more than once ("looping" back through pages of the decision aid), patients reported improved satisfaction with shared decision making and all subcomponents. Overall satisfaction, perceived support, certainty, and perceived effectiveness of decision-making were lowest when a high number of navigating clicks occurred absent "looping."
Linguistic features of patient-provider communication and system use data of a decision aid predict patients' satisfaction with shared decision making. Our findings have implications for the design of decision aid tools and clinician training to support more effective shared decision-making for screening mammography.
临床决策辅助工具可以支持筛查性乳房 X 光摄影的共同决策。为了促进患者和其提供者之间的共同决策，本研究考察了使用电子健康记录（EHR）集成决策辅助工具和伴随的医患口头交流的模式如何预测决策满意度。
在 51 次使用乳房 X 光摄影决策辅助工具的患者就诊中，从转录的音频记录和自动捕获决策辅助工具使用情况的系统日志中提取医患口头交流的语言特征。调查评估了患者就诊后的决策满意度及其子成分。线性混合效应模型评估了患者对决策的满意度如何与其口头交流模式和决策辅助工具的使用相关。
结果表明，在就诊期间，提供者使用定量语言与患者的整体满意度、感到知情和价值观清晰度呈正相关。患者的提问与整体满意度、价值观清晰度和确定性感知呈负相关。当系统使用数据表明双方多次循环通过决策过程（多次“循环”浏览决策辅助工具的页面）时，患者报告共享决策和所有子成分的满意度提高。当出现大量无“循环”的导航点击时，整体满意度、感知支持、确定性和决策的有效性最低。
医患交流的语言特征和决策辅助工具的系统使用数据预测了患者对共同决策的满意度。我们的研究结果对决策辅助工具的设计和临床医生培训有一定的启示，有助于促进筛查性乳房 X 光摄影的更有效的共同决策。
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