Creating a Measure of Shared Decision-Making for Healthcare Decisions With Aboriginal and Torres Strait Islander People: A Hybrid Yarning and Modified Delphi Study

Objectives

Shared decision making (SDM) is a process which involves an exchange of information between healthcare professionals and patients about options (including watch and wait) and the patient's preferences. It is recognised as an important part of person-centred health care and is part of national standards for delivery of care in Australia. SDM improves health outcomes and SDM resources specifically designed with and for Aboriginal and Torres Strait Islander communities are increasingly available. However, there is no culturally appropriate measure to evaluate the SDM process and the impact of these resources. The objective was to create a culturally safe measure of SDM for Aboriginal and Torres Strait Islander people and communities using the nine-item SDM-Q-9 as a starting point.

Methods

A purposively invited expert panel of Aboriginal and Torres Strait Islander Health Professionals and Community members and experts in SDM attended a hybrid yarning briefing session incorporating yarning (a cultural approach to dialogue). The panel then participated in a two round online survey Delphi process. Study team members reviewed the yarning session, developed themes to apply to questions for the Delphi rounds. Team members analysed and reported results of each round to participants and proposed the final measures based on feedback in each round.

Results

Eighteen of 26 invited participants attended the yarning briefing session and 14 participated in both Delphi rounds. Consensus was reached for a measure with 12 items, their wording and the cultural concepts supporting each. The resulting measure included new wording for all items and the addition of three items. From the yarning session the need for a short measure resulted in a proposed five-item version of the measure with the basic aspects of SDM was also agreed on in the Delphi process. Both measures will continue for next stage testing.

Conclusions

Using a hybrid yarning and Delphi method resulted in a culturally adapted measure of SDM. Validation and real-world testing of the measure are planned for the 12- and 5-item version created.

Practice Implications

Once validated, this co-created culturally responsive measure will be used to assess the efficacy of processes and tools to support shared decision making with Aboriginal and Torres Strait Islander people.

Patient or Public Contribution

An Aboriginal and Torres Strait Islander Governance Group provided oversight and guidance throughout the project, ensuring it was shaped by Indigenous knowledge, cultural protocols, and ethical principles. The Group emphasised reciprocal learning, respect for diverse knowledge systems, and the use of Aboriginal and Torres Strait Islander research methods. It supported community benefit, collaborative cultural approaches, and Indigenous-led decision-making. The Group also ensured findings were prepared and shared in culturally safe ways, recognising knowledge ownership and appropriate dissemination. Additionally, it advised on future directions, strengthening the project's ongoing impact while maintaining alignment with Aboriginal and Torres Strait Islander values, priorities, and processes. Governance group chairs were observers at the yarning session and no Governance Group members were part of the Delphi process.