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Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared
Jürgen Kasper1, Christoph Heesen, Sascha Köpke
1Institute of Neuroimmunology and Clinical MS Research, University Medical Center Hamburg, Hamburg, Germany.
Plos One
|November 2, 2011
Summary
Measuring patient involvement in shared decision-making (SDM) is crucial but challenging. Current SDM measures lack a unified construct, making it difficult to assess patient involvement effectively.
Area of Science:
- Medical decision-making
- Evidence-based medicine
- Patient communication
Background:
- Shared decision-making (SDM) is vital in evidence-based medicine for informed patient choices.
- Defining, implementing, and evaluating patient involvement in SDM remains unclear.
- The study investigated the efficacy of four measures for indicating patient involvement.
Purpose of the Study:
- To assess the ability of four distinct measures to accurately reflect patient involvement in medical decisions.
- To examine the convergent validity between observer ratings and patient perceptions of communication during consultations.
- To address the questionable assumption of overlap in constructs measured by different SDM instruments.
Main Methods:
- A nested cohort of 79 participants from a randomized trial on multiple sclerosis immunotherapy decision aids was studied.
- Convergent validity was assessed between observer ratings (OPTION) and patient perceptions (SDM Questionnaire, Control Preference Scale, Decisional Conflict Scale).
- Videotaped physician-patient consultations were analyzed using the OPTION instrument.
Main Results:
- The OPTION measure demonstrated high to excellent reliability.
- Observer ratings (OPTION) indicated low communication performance, contrasting with high patient-reported performance.
- No significant correlations were found between observer and patient ratings, though moderate correlations existed among patient-reported measures.
Conclusions:
- Existing shared decision-making measures do not capture a single, consistent construct.
- A validated gold standard is needed to reliably indicate patient involvement in clinical decision-making.
- The heterogeneity of SDM constructs complicates the interpretation of evidence on SDM efficacy, suggesting a need for inter-subjective measurement focus.
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