Measuring what matters- patient and clinician priorities for clinical decision support interactions: a modified Delphi study

Patient-centered clinical decision support (PC CDS) is a spectrum of digital tools intended to support patient and clinician decision making. Patient-clinician interaction is key to PC CDS, and patient-clinician interaction measurement areas assess how PC CDS impacts the care process and experiences a patient has accessing and receiving healthcare. Identifying measures that assess if and how PC CDS influences outcomes is essential to measuring impact, but it is unclear what outcomes patients and physicians consider important. This study aimed to develop a prioritized list of measurement areas informed by patients and primary care physicians (PCPs) to inform considerations for measuring patient-clinician interaction for PC CDS. We conducted a modified Delphi study to understand patients’ and PCPs’ perspectives on the importance of fifteen previously identified patient-clinician interaction measurement areas for PC CDS. We conducted a three-round process with nine patients and nine PCP participants: (1) rating importance of measurement areas, (2) online discussion of ratings, and (3) forced-choice ranking activity of measurement areas. Patients and PCPs generally agreed about the importance of communication quality and trust in clinicians, and the interconnectedness of these areas. They additionally agreed that the relative importance of measurement areas depends on context and described contextual factors such as care expectations and patient complexity. Patients and PCPs also agreed that satisfaction, decision regret and discharge preparedness are of lower importance for PC CDS measurement. However, patients and PCPs had differing views on the importance of measuring access to information, decision quality and self-management. Patients ranked access to information higher than PCPs, while PCPs ranked decision quality and self-management higher than patients. Assessments of PC CDS effectiveness should consider what outcomes are most important to CDS end-users. Measurement of PC CDS is limited by logistics and feasibility considerations, and researchers should examine the outcomes assessed in PC CDS studies and identify opportunities to assess measurement areas important to key stakeholders. The results of this activity highlight areas for future work, including the importance of understanding how measurement of these areas may be impacted by context (e.g. patient complexity, disease status).