Psychometric evaluation of a decision quality instrument for medication decisions for treatment of depression symptoms

Suzanne Brodney,K D Valentine,Karen Sepucha

doi:10.1186/s12911-021-01611-w

Abstract

BackgroundA high quality treatment decision means patients are informed and receive treatment that matches their goals. This research examined the reliability and validity of the Depression Decision Quality Instrument (DQI), a survey to measure the extent to which patients are informed and received preferred treatment for depression.MethodsParticipants were aged 18 and older from 17 US cities who discussed medication or counseling with a physician in the past year, and physicians who treated patients with depression who practiced in the same cities. Participants were mailed a survey that included the Depression-DQI, a tool with 10 knowledge and 7 goal and concern items. Patients were randomly assigned to either receive a patient decision aid (DA) on treatment of depression or no DA. A matching score was created by comparing the patient’s preferred treatment to their self-reported treatment received. Concordant scores were considered matched, discordant were not. We examined the reliability and known group validity of the Depression-DQI.ResultsMost patients 405/504 (80%) responded, 79% (320/405) returned the retest survey, and 60% (114/187) of physicians returned the survey. Patients’ knowledge scores on the 10-item scale ranged from 14.6 to 100% with no evidence of floor or ceiling effects. Retest reliability for knowledge was moderate and for goals and concerns ranged from moderate to good. Mean knowledge scores differentiated between patients and physicians (M = 63 [SD = 15] vs. M = 81 [SD = 11], p < 0.001), and between patients who did and didn’t receive a DA (M = 64 [SD = 16] vs. M = 61 [SD = 14], p = 0.041). 60.5% of participants received treatment that matched their preference. Based on the multivariate logistic regression, ‘avoiding taking anti-depressants’ was the only goal that was predictive of taking mediation (OR = 0.73 [0.66, 0.80], p < 0.01). Shared Decision Making Process scores were similar for those who matched their preference and those who didn’t (M = 2.18 [SD = 0.97] vs. M = 2.06 [SD = 1.07]; t(320) = − 1.06, p = 0.29). Those who matched had lower regret scores (matched M = 1.72 [SD = 0.74] vs. unmatched M = 2.32 [SD = 0.8]; t(301) = − 6.6, p < .001).ConclusionsThe Depression DQI demonstrated modest reliability and validity. More work is needed to establish validity of the method to determine concordance.Trial registration: NCT01152307.

Highlights

A high quality treatment decision means patients are informed and receive treatment that matches their goals
Brodney et al BMC Med Inform Decis Mak (2021) 21:252 a shared decision making (SDM) approach to help patients decide between psychotherapy or medication as initial treatment
The goal of SDM is to improve the quality of treatment decisions [8]

Summary

Introduction

A high quality treatment decision means patients are informed and receive treatment that matches their goals. This research examined the reliability and validity of the Depression Decision Quality Instrument (DQI), a survey to measure the extent to which patients are informed and received preferred treatment for depression. In order for a decision to be considered ‘high quality’ two conditions must be met: (1) patients need to be informed, meaning they understand the basic facts about their condition and their treatment choices, and (2) the treatment that the patient receives should match their goals [9]. Patients with depression who had less formal education were less informed, less involved in the decision making process and less likely to report they would make the same decision again [13]. Promoting SDM may result in better quality decisions, but there is no validated measure of the quality of depression treatment decisions

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Results

Discussion

Conclusion