https://www.selleckchem.com/products/ncb-0846.html ICCs for mean scores for pairs among the three remaining raters was 0.81 to 0.84. Mean JSEO scores from the four raters correlated with the JSPPPE (rho = 0.45, p = 0.03) and IC (rho = 0.68, p less then 0.001), but not the EEC (rho = 0.345, p = 0.1). Conclusions We found validity evidence for the use of a modified JSPPPE for an observer to assess empathy in a recorded encounter with a SP. This may be useful as medical educators shift toward competency-based tracking. The brevity of this tool and potential assessment using video are also appealing.Objective Caregivers of children with medical complexity (CMC) face decisions about tracheostomy. The objectives of this paper are to identify facilitators and barriers to tracheostomy decision-making (TDM) process for CMC. Methods Using phenomenology as its methodologic orientation, this qualitative study conducted in North Carolina between 2013 and 2015, consists of semi-structured interviews with 56 caregivers of 41 CMC who received tracheostomies, and 5 focus groups of 33 healthcare providers (HCP) at a tertiary care children's hospital involved in TDM for CMC. Participants were asked to share their experiences and perspectives on the TDM process. Qualitative data were transcribed, coded, and organized into themes as is consistent with thematic content analysis. Results Five themes were identified. 1) Caregivers perceived decision about tracheostomy for their children was theirs to make. 2) Strategies that increased caregivers' active participation in the TDM process facilitated the TDM process. 3) Caregiver emotional stress and lack of understanding about tracheostomy were barriers. 4) Good HCP communication during the TDM process was valued; poor communication was a barrier. 5) Collaboration among HCP facilitated TDM, especially when nurses were involved, whereas fragmentation in care was a barrier. Conclusions Caregivers take a primary role in the TDM process. Many ca