Patients' and Observers' Perceptions of Involvement Differ. Validation Study on Inter-Relating Measures for Shared Decision Making

Jürgen Kasper,Gary Fulcher,Christoph Heesen,Friedemann Geiger,Sascha Köpke,Markus Reindl

doi:10.1371/journal.pone.0026255

Abstract

ObjectivePatient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered.MethodsThe study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale).ResultsOPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations.ConclusionExisting SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement.Practice ImplicationsPronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement.Trial RegistrationControlled-Trials.com ISRCTN25267500.

Highlights

The aim of evidence based medicine (EBM) is to provide the means by which current best evidence from research can be applied to medical decision making [1]
Existing shared decision making’ method (SDM) measures do not refer to a single construct
Practice Implications: Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM

Summary

Introduction

The aim of evidence based medicine (EBM) is to provide the means by which current best evidence from research can be applied to medical decision making [1]. The latter has been conceived as the ‘shared decision making’ method (SDM), a communication strategy to involve patients into the process of making their medical decisions Following this concept, patient involvement implies a two way exchange of information between doctor and patient where options are made explicit, appraisal of current best evidence is negotiated, and patient desires are elicited [3]. Patient involvement implies a two way exchange of information between doctor and patient where options are made explicit, appraisal of current best evidence is negotiated, and patient desires are elicited [3] This style of communication contrasts the traditional benevolent paternalism where patients are assigned to a passive role in the decision making process [3]. Apart from ethical guidelines [4] and patients’ pronounced role preferences for more participation in decision making [5], this view is supported by efficacy studies

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Conclusion