PROJECT SUMMARY Shared decision-making (SDM) is an active process of clinician and patient interaction that is intended to produce a joint decision. Critical to the implementation of SDM and the evaluation of its effect on health outcomes is the availability of valid and reliable instruments to measure SDM. Though several instruments have been designed to measure the process of arriving at a shared decision in the clinical encounter, few have been deemed high quality and none have been specifically designed to measure the process of SDM in pediatrics. Furthermore, most instruments measure the SDM process from a singular perspective (e.g., patient self-report or observer) despite increasing recognition that clinician perspectives are also needed to accurately capture the dyadic interaction and inherently bidirectional process of SDM. The primary goal of this project is to develop and evaluate a dyadic instrument to measure the process of SDM with parents of young children that includes both parent and clinician perspectives. We will anchor the development of this instrument to a 4-step process for implementing SDM in pediatrics that we developed and validated in preliminary work using a diverse set of decision-making scenarios across multiple pediatric disciplines and varied clinical settings. The first 3 steps of this process involve recognition of [>1] medically reasonable option (Step 1); clinician assessment of the medical benefit-burden ratios of options (Step 2); and parent expression of preferences regarding options (Step 3). Step 4 encourages a parent- or clinician-guided SDM based on Steps 1-3 that can be further modified based on the presence of other decisional features. Our specific aims are to (1) develop a dyadic instrument for measuring the SDM process with parents of young children using a standard, iterative process that includes item generation, augmentation of the item pool, item reduction through expert review, and pretesting with parents and clinicians, with a sub-aim to develop an observer-coded version of the instrument to explore its correlation with the final dyadic instrument in Aim 3; (2) assess the [internal consistency], construct validity and reliability of the preliminary dyadic instrument in a controlled, simulated setting by conducting an online experiment in which [parent (N=600) and clinician (N=600) participants] complete our preliminary dyadic instrument after being randomized to view one of 4 different pairs of standardized video vignettes that portray a high-quality and low-quality SDM encounter of a unique decision in pediatrics; and (3) evaluate the construct validity and feasibility of the final dyadic instrument in the clinical setting by administering the instrument to parent and clinician participants after [problem-based encounters (N=127)] across a range of pediatric settings and specialties at two pediatric institutions, [with a sub-aim to develop a Spanish version of the final dyadic instrument.]...