Methods: 258 men with localized prostate cancer (PSA<20, Gleason score of 6 or 7) from 4 VA hospitals had their diagnosis visits recorded. As reported previously, men had received one of two decision aids, varying by literacy level, but not content. Time in minutes was obtained from audio recordings. Quality of informing was measured using the Informed Decision Making (IDM) method developed by Braddock, et al. (IDM scale possible range=0-18). Transcripts were scored independently by two trained raters and disagreements resolved by consensus. Treating urologists were mostly senior residents who did not receive special training in shared decision-making.
Results: Preliminary data analysis in 211 encounters with complete IDM scores showed a correlation of .25 between time in the encounter and quality of informing. Observed range of IDM scores was 0-15, suggesting physician performance from poor to excellent. IDM scores showed modest quality (IDM M+SD=7.63±2.47). Observed range of encounter times was 6 to 59 minutes (min M+SD =23±10). Analysis of times by quartile quality (IDM) scores shows that the top quartile (IDM M+SD =10.6±1.2) and the bottom quartile (IDM M±SD =4.4±1.5) were similar in the length of the appointment (min M±SD =26±11; min M±SD =22±12 respectively). Times were highly variable, as were IDM scores.
Conclusions: The low correlation between time spent in the encounter and the quality of physician informing suggests that higher quality informing does not require more time even in complex, multiple option decision encounters. This suggests it is very important to identify critical shared decision making skills for physician training. A parsimonious skill model for high quality informed and shared decision making may be attainable, though even in the top quartile of IDM scores, improvement is needed.