Graduation Year

2024

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Public Health

Major Professor

Deborah Cragun, Ph.D.

Committee Member

Nevena Krstic, MS.

Committee Member

Marleah Kruzel, Ph.D.

Keywords

patient outcomes, FOCUS model, service evaluation, OPTION5

Abstract

Shared decision-making (SDM), defined as the collaborative process between patient and healthcare provider to arrive at a values-based clinical decision, may be valuable in genetic counseling (GC) given that patients are often faced with various options. Four published studies have measured or made conclusions about the use of SDM skills in GC settings, but only one study evaluated relationships between third-party observations of SDM in recorded GC sessions and patient-reported outcomes (i.e., anxiety and decisional conflict) and found no correlations between these measures. The purpose of this study was to evaluate relationships between SDM and measures of patient-reported experience (i.e., perceptions of GC quality and autonomy support) and decisional conflict using recordings from 20 prenatal sessions with standardized patients (SPs). Five prenatal counselors completed both pre- and post-test GC sessions with the same patient actors who were being seen for two different indications. In the first indication, one SP was deciding whether to pursue noninvasive prenatal screening (NIPS) during her current pregnancy (pre-test) and what to do after a positive NIPS (post-test). In the second indication, the remaining two SPs were partners deciding whether to undergo carrier screening before trying to start a family together (pre-test) and what to do once screening identified one partner as a carrier (post-test). To assess whether SDM skills may influence patient experiences or outcomes, we calculated Kendall Tau correlations between SDM scores that were measured using the ‘Observing Patient Involvement in Decision Making’ (OPTION 5) tool with the following three patient-reported measures: 1) SP perceptions of autonomy support (measured via the healthcare climate questionnaire), 2) SPs quality ratings of GC, and 3) extent to which patient actors felt conflicted versus empowered to make a decision (using scores from the SURE measure). Although SDM scores were not correlated with the SURE measure, autonomy support was positively correlated with both SDM (r =0.57, p < 0.001) and the SURE measure (r =0.38, p <0.001). Additionally, SDM scores were moderately correlated with SP quality ratings (r =0.46, p= 0.01). These results provide preliminary evidence to suggest that the use of SDM skills may result in more positive patient experiences, specifically contributing to patient perceptions of session quality and autonomy support. However, it remains uncertain whether SDM impacts downstream outcomes such as decisional conflict, and future studies are needed to determine whether these findings are consistent in other patient contexts.

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