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      Evaluating the quality of shared decision making during the patient-carer encounter: a systematic review of tools

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          Abstract

          Background

          The concept of shared decision making (SDM) has been developing in many countries since the 1990s. The main challenge of SDM, based on the principles of respect for the person’s autonomy, is to improve patients’ participation, should they so wish, in decisions concerning their personal health. To our knowledge, there is only one SDM evaluation tool validated in metropolitan French that does not measure the entire SDM construct. The aim of this review was to identify existing and validated SDM measurement tools to determine which of them could be adapted in French to cover all the dimensions of SDM.

          Methods

          A systematic literature review was conducted based on articles found in the PubMed and PsycINFO bibliographic databases and published between 2010 and 2014. Studies were included if the main goal of the article was the development and psychometric validation of an SDM measurement tool, not specific to any given disease or situation, in English, French and Spanish. We used the nine essential elements of the Makoul and Clayman’s integrative model to describe the different existing tools.

          Results

          Nineteen studies were included. Seven new tools had been published since Scholl’s previous review in 2011. We observed a recent spread of the multi-appraiser approach, which combines points of view of patients, healthcare professionals and sometimes external observers. Several models were used for the development of the seven newly identified tools. None of the identified tools assessed the nine elements of the Makoul’s model. Three of these elements, however, were systematically measured in each of the new tools: “defining/explaining the problem”, “patient values/preferences”, and “checking/clarifying understanding”.

          Conclusions

          We identified several potentially interesting tools for the French context which could cover the whole elements of Makoul’s model. The next step will be the development of a French-language instrument based on these tools.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13104-016-2164-6) contains supplementary material, which is available to authorized users.

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          Most cited references41

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          An integrative model of shared decision making in medical encounters.

          Gregory Makoul, Marla L. Clayman (2006)
          Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
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            The Psychometric Properties of CollaboRATE: A Fast and Frugal Patient-Reported Measure of the Shared Decision-Making Process

            Paul James Barr, Rachel Thompson, Thom Walsh … (2014)
            Background Patient-centered health care is a central component of current health policy agendas. Shared decision making (SDM) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace. However, the measurement of SDM continues to prove challenging. Reviews have highlighted the need for a patient-reported measure of SDM that is practical, valid, and reliable to assist implementation efforts. In consultation with patients, we developed CollaboRATE, a 3-item measure of the SDM process. Objective There is a need for scalable patient-reported measure of the SDM process. In the current project, we assessed the psychometric properties of CollaboRATE. Methods A representative sample of the US population were recruited online and were randomly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013. Three dimensions of SDM were manipulated in the encounters: (1) explanation of the health issue, (2) elicitation of patient preferences, and (3) integration of patient preferences. Participants then completed CollaboRATE (possible scores 0-100) in addition to 2 other patient-reported measures of SDM: the 9-item Shared Decision Decision Making Questionnaire (SDM-Q-9) and the Doctor Facilitation subscale of the Patient’s Perceived Involvement in Care Scale (PICS). A subsample of participants was resurveyed between 7 and 14 days after the initial survey. We assessed CollaboRATE’s discriminative, concurrent, and divergent validity, intrarater reliability, and sensitivity to change. Results The final sample consisted of 1341 participants. CollaboRATE demonstrated discriminative validity, with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero (mean score: 46.0, 95% CI 42.4-49.6) to 3 (mean score 85.8, 95% CI 83.2-88.4). CollaboRATE also demonstrated concurrent validity with other measures of SDM, excellent intrarater reliability, and sensitivity to change; however, divergent validity was not demonstrated. Conclusions The fast and frugal nature of CollaboRATE lends itself to routine clinical use. Further assessment of CollaboRATE in real-world settings is required.
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              Informed decision making in outpatient practice: time to get back to basics.

              C Braddock, K A Edwards, N Hasenberg … (2015)
              Many clinicians have called for an increased emphasis on the patient's role in clinical decision making. However, little is known about the extent to which physicians foster patient involvement in decision making, particularly in routine office practice. To characterize the nature and completeness of informed decision making in routine office visits of both primary care physicians and surgeons. Cross-sectional descriptive evaluation of audiotaped office visits during 1993. A total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons; 2 to 12 patients were recruited from each physician's community-based private office. Analysis of audiotaped patient-physician discussions for elements of informed decision making, using criteria that varied with the level of decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic decisions included discussion of the nature of the decision and asking the patient to voice a preference; other categories had criteria that were progressively more stringent. The 1057 audiotaped encounters contained 3552 clinical decisions. Overall, 9.0% of decisions met our definition of completeness for informed decision making. Basic decisions were most often completely informed (17.2%), while no intermediate decisions were completely informed, and only 1 (0.5%) complex decision was completely informed. Among the elements of informed decision making, discussion of the nature of the intervention occurred most frequently (71 %) and assessment of patient understanding least frequently (1.5%). Informed decision making among this group of primary care physicians and surgeons was often incomplete. This deficit was present even when criteria for informed decision making were tailored to expect less extensive discussion for decisions of lower complexity. These findings signal the need for efforts to encourage informed decision making in clinical practice.
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                Author and article information

                Contributors
                Nathalie Bouniols:
                ORCID: http://orcid.org/0000-0001-6001-8307
                +33 (0)2.40.84.69.20 , nathalie.bouniols@gmail.com
                Brice Leclère: brice.leclere@chu-nantes.fr
                Leïla Moret: leila.moret@chu-nantes.fr
                Journal
                Journal ID (nlm-ta): BMC Res Notes
                Journal ID (iso-abbrev): BMC Res Notes
                Title: BMC Research Notes
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1756-0500
                Publication date (Electronic): 2 August 2016
                Publication date PMC-release: 2 August 2016
                Publication date Collection: 2016
                Volume: 9
                Electronic Location Identifier: 382
                Affiliations
                [1 ]Medical Evaluation and Epidemiology Department, PHU11, Saint-Jacques University Hospital, 85, rue Saint-Jacques, 44093 Nantes Cedex, France
                [2 ]EA 4275 SPHERE: biostatistics, Pharmacoepidemiology and Human sciences Research team, Faculty of Pharmaceutical Sciences, University of Nantes, Rue Gaston Veil, 44000 Nantes, France
                Author information
                http://orcid.org/0000-0001-6001-8307
                Article
                Publisher ID: 2164
                DOI: 10.1186/s13104-016-2164-6
                PMC ID: 4971727
                PubMed ID: 27485434
                SO-VID: 68c837cc-ce94-4380-8cad-7f54a99d7632
                Copyright © © The Author(s) 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 5 March 2016
                Date accepted : 14 July 2016
                Funding
                Funded by: Centre Hospitalier Universitaire de Nantes, France
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Medicine
                Keywords: shared decision making,patient involvement,measurement,questionnaire,methodology,systematic review
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: shared decision making, patient involvement, measurement, questionnaire, methodology, systematic review

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