Audit and feedback using the brief Decision Support Analysis Tool (DSAT-10) to evaluate nurse-standardized patient encounters

Patient Educ Couns. 2008 Dec;73(3):519-25. doi: 10.1016/j.pec.2008.07.016. Epub 2008 Aug 21.


Objective: To evaluate the brief Decision Support Analysis Tool (DSAT-10) for auditing the quality of nurse-standardized patient encounters, structuring feedback for nurses, and testing instrument reliability.

Methods: A systematic process was used to develop standardized patient scenarios, pilot-test scenarios, calibrate DSAT-10 coders, analyze taped telephone encounters using DSAT-10, and provide feedback. Inter-rater reliability was calculated using coder agreement, kappa, and intra-class correlation coefficients.

Results: Six scenarios portrayed patients' decisional uncertainty from either: pressure from others (n=2), unclear values (n=2), or inadequate information (n=2). Scenarios were easy to use over the telephone, produced realistic role performance, and were practical for audio-recording interactions. DSAT-10 analysis of 76 nurse-standardized patient encounters revealed nurses' strengths (e.g., information provision) and their limitations (e.g., lack of discussion of values and/or support needs). Scores discriminated between trained and untrained nurses. The kappa coefficient over all items was 0.55 (95% CI: 0.49, 0.61) with higher agreement for encounters involving trained nurses (0.62; 95% CI: 0.43, 0.80).

Conclusion: Auditing nurse-standardized patient encounters using DSAT-10 and providing feedback to nurses was feasible. Although DSAT-10 items had adequate inter-rater reliability and discriminated between trained/untrained nurses, some items were problematic.

Practice implications: Providing feedback on nurse encounters with standardized patients experiencing uncertainty has the potential to enhance nurses' decision support skills.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Clinical Competence* / standards
  • Communication
  • Decision Support Techniques*
  • Discriminant Analysis
  • Education, Nursing, Continuing
  • Feasibility Studies
  • Feedback, Psychological
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nurse-Patient Relations*
  • Nursing Audit / methods*
  • Nursing Audit / standards
  • Nursing Evaluation Research
  • Nursing Staff / education
  • Nursing Staff / psychology
  • Observer Variation
  • Patient Participation* / methods
  • Patient Participation* / psychology
  • Patient Simulation*
  • Social Support
  • Telephone
  • Uncertainty