“…Items assessing trust and shared decision-making were analyzed individually and coded dichotomously as better ("always") versus worse ("never"/"sometimes"/"usually") quality, based on the distribution of responses, as few participants reported worse quality ( Table 2). The CAHPS communication items have high internal consistency 15,21 and were combined to create a CAHPS summary variable for each participant who responded to as least two CAHPS items. A participant who answered "always" for all CAHPS items was classified as having better quality communication, whereas one who responded "never", "sometimes", or "usually" to any of the items was classified as having worse quality.…”