Do Shared Decision-Making Measures Reflect Key Elements of Shared Decision Making? A Content Review of Coding Schemes

Area of Science:

• Healthcare Research
• Clinical Practice Guidelines
• Patient-Centered Care

Background:

• Growing demand for validated measures of shared decision-making (SDM).
• Existing observer-based coding schemes for SDM require evaluation for completeness.
• Ensuring comprehensive assessment of SDM is critical for improving patient care.

Purpose of the Study:

• To evaluate whether current shared decision-making (SDM) observer-based coding schemes adequately assess the four core elements of SDM.
• Identify gaps in existing SDM measurement tools.
• Provide recommendations for improving SDM assessment.

Main Methods:

• Systematic extraction and categorization of items from 12 SDM observer-based coding schemes.
• Independent and duplicate categorization by two researchers.
• Analysis focused on alignment of items with the four key SDM elements: fostering choice awareness, informing about options, discussing patient preferences, and making a decision.

Main Results:

• Only 5 out of 12 (42%) coding schemes assessed all four key SDM elements.
• Seven schemes failed to measure "fostering choice awareness," and three omitted "discussing patient preferences."
• A significant portion (36%) of items could not be classified into key SDM elements, with "informing about options" being the most frequently assessed element (46%).

Conclusions:

• Existing shared decision-making (SDM) coding schemes frequently fail to assess all essential SDM components.
• Current tools demonstrate a bias towards information provision, with underrepresentation of other vital SDM elements.
• Caution is advised when interpreting scores from current SDM coding schemes due to their limitations.