Abstract
ObjectiveTo inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.MethodsIn a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.ResultsWe included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.ConclusionsDue to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument’s content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.
Highlights
There is growing recognition that shared decision making (SDM) is imperative as a decision making model in clinical practice when more than one option is medically relevant or when patient preferences vary strongly
To prevent any conflict of interest based co-authorship of articles that were included in this review, members of our research team who were involved in the development and or validation of a specific instrument were not involved in the quality appraisal of these instruments: Isabelle Scholl was involved in the development and validation of the following instruments: SDM-Q-9 [29, 69], SDM-Q-9 (Spanish) [32], SDM-Q-9 (Dutch) [33], SDM-Q-9 Psy (Hebrew) [34], SDMQ-Doc [35], SDM-Q-Doc (Dutch) [33]
Pieterse was involved in the development and validation of the following instruments: SDM-Q-9 (Dutch) [33], SDM-Q-Doc (Dutch), OPTION12 (Dutch) [56], OPTION5 (Dutch) [55]
Summary
There is growing recognition that shared decision making (SDM) is imperative as a decision making model in clinical practice when more than one option is medically relevant or when patient preferences vary strongly. It is notable that the SDM measures used vary greatly with regard to their characteristics, such as the source of the data and the perspective of the scorers (self-report questionnaires based on the experience of patients or providers versus coding schemes applied by independent raters to audio- or video-taped consultations) [12]. These differences can impact research outcomes, as might be the case for a review on the relationship between SDM and patient health outcomes which found that the perspective from which SDM is measured affects the associations found with health outcomes [8]. To assist researchers in their choice of the most feasible, reliable, and valid SDM measure, and to optimally improve existing instruments, insight into measurement quality of the existing measures is needed
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