Table 3.
Results of the Delphi ratings by round
| 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 | ||
*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.
**17 experts participated in Round 2, and 16 in Rounds 3 and 4.
†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.