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Table 3 Results of the Delphi ratings by round

From: Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters

Items after Round 1*

Round 2**

(n = 17)

Round 3**

(n = 16)

Round 4**

(n = 16)

Final result

Habit 1: Invest in the beginning

Make personal remarks (original)

1/17†

0

Drop

Drop

Respond to clinician's welcome (modification)

7/17

8/16

8/16

--

Engage in social talk until welcome (modification)

4/17

2/16

2/16

--

Return the physician's greeting (modification)

3/17

3/16

2/16

--

Remove "make personal remarks" from this habit

2/17

3/16

4/16

--

Disclose relevant concerns (original)

6/17

1/16

Drop

Drop

Disclose all relevant concerns to the best of my knowledge (modification)

2/17

2/16

Drop

Drop

Share all relevant concerns (modification)

9/17

13/16

 

Retain

Remove "disclose relevant concerns" from this habit

0

Drop

 

Drop

Articulate priorities (original)

9/17

6/16

2/16

Drop

State which concerns are most important (modification)

8/17

10/16

14/16

Retain

Remove "articulate priorities" from this habit

0

Drop

 

Drop

Approve or modify stated agenda (addition)

10/16

15/16

 

Retain

Set the agenda for the visit (addition)

11/17

11/16

9/16

--

Solicit the physician's goals for the visit (addition)

7/16

4/16

Drop

Drop

Explain how one learns best (addition)

3/16

Drop

 

Drop

Greet or verbally welcome the physician (addition)

11/16

13/16

 

Retain

Habit 2: Provide your perspective

Express preferences (original)

14/17

  

Retain

Share values (modification)

2/17

Drop

 

Drop

Remove "express preferences" from this habit

1/17

  

Drop

Express expectations (original)

5/17

5/16

9/16

--

State specific requests (modification)

2/17

1/16

1/16

--

Share wishes and expectations (modification)

5/17

5/16

2/16

--

Express hopes, desires, and expectations (modification)

5/17

5/16

4/16

--

Remove "express expectations" from this habit

0

  

Drop

Describe impact (original)

2/17

  

Drop

Tell how illness affects daily life (modification)

15/17

  

Retain

Remove "describe impact" from this habit

0

  

Drop

Participate in visit (original)

6/17

7/16

7/16

--

Provide details about symptoms, concerns, and previous treatments (modification)

3/17

6/16

4/16

--

Give opinions about possible causes of illness (modification)

0

  

Drop

Answer questions in reasonable detail, raise new comments, demonstrate respect (modification)

3/17

0

 

Drop

Remove "participate in visit" from this habit

5/17

3/16

5/16

--

Tell story (original)

7/17

8/16

12/16

Retain

Offer information about medical history (modification)

1/17

0

 

Drop

Tell the whole story of illness (modification)

3/17

2/16

0

Drop

Tell the whole story of your concern(s) (modification)

3/17

3/16

0

Drop

Tell story with answers to Kleinman's explanatory model questions (modification)

2/17

2/16

1/16

Drop

Remove "tell story" from this habit

1/17

1/16

3/16

Drop

Explain personal beliefs or worries about symptoms (addition)

15/15

  

Retain

Honestly point out when areas are left unaddressed (addition)

7/15

11/16

15/16

Retain

State own understanding of problem (explanatory model) with physician (addition)

11/17

14/16

 

Retain

Give frank opinions about choices offered (addition)

9/16

15/16

 

Retain

Offer explanations (addition)

3/15

  

Drop

Ask questions about explanations and choices (addition)

13/17

  

Retain

Habit 3: Communicate about your feelings and concerns

Express feelings and concerns (original)

8/17

13/16

 

Retain

Discuss psychosocial issues and express feelings and concerns (modification)

3/17

0

 

Drop

Express and elaborate on feelings and concerns (modification)

6/17

3/16

 

Drop

Remove "express feelings and concerns" from this habit

0

  

Drop

Explore impact of feelings and concerns on health (addition)

5/16

7/16

9/16

--

Respond to physician's expression of empathy (addition)

5/15

4/16

 

Drop

Talk openly about psychosocial issues (addition)

7/16

13/16

 

Retain

Listen to physician for understanding (addition)

4/16

  

Drop

Habit 4: Invest in the end

Use own language and terms to describe diagnosis (original)

1/17

  

Drop

Use own language and terms to describe diagnosis, evaluation or treatment plans (modification)

12/17

  

Retain

Remove "use own language and terms to describe diagnosis" from this habit

4/17

  

Drop

Participate in decision making (original)

3/17

4/16

2/16

--

Express level of participation in decision making desired and participate to that extent (modification)

8/17

10/16

11/16

--

Make opinions or concerns about choices known (modification)

2/17

1/16

1/16

--

State preferences about tests or treatment options (modification)

4/17

1/16

2/16

--

Remove "participate in decision making" from this habit

0

  

Drop

Restate recommendations and information provided by doctor (original)

8/17

9/16

13/16

Retain

Restate decisions made during the visit (modification)

8/17

5/16

2/16

Drop

Remove "restate recommendations and information provided by doctor" from this habit

1/17

2/16

1/16

Drop

Ask questions (original)

17/17

  

Retain

Remove "ask questions" from this habit

0

  

Drop

Seek clarifying information (original)

16/17

  

Retain

Remove "seek clarifying information" from this habit

1/17

  

Drop

Describe any barriers to following the treatment plan (addition)

14/16

  

Retain

Ask the doctor to explain any words or ideas that are confusing (addition)

13/17

  

Retain

Explore barriers to implementing the plan (addition)

8/17

12/16

 

Retain

Answer the "Ask me 3" questions (addition)

7/17

7/16

15/16

Drop

Ask about options interested in but not mentioned by the doctor (addition)

13/17

  

Retain

  1. *Original behaviors were proposed by the project team. During Round 1 the experts suggested modifications to the original behaviors and behaviors that should be added (i.e., additions) to the Model.
  2. **17 experts participated in Round 2, and 16 in Rounds 3 and 4.
  3. †In each round, the experts rated each behavior (agree or disagree) for their fit with a particular habit; each column includes the percent agreement received by each behavior. Behaviors that received more than 70% of the experts votes (either disagree or agree) were defined as achieving consensus (either retain or drop). Behaviors that received 0 votes were not included in subsequent rounds or ratings.