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Health Expect. 2016 Oct;19(5):993-1001. doi: 10.1111/hex.12380. Epub 2015 Jun 25.

Measurement challenges in shared decision making: putting the 'patient' in patient-reported measures.

Author information

1
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA. paul.j.barr@dartmouth.edu.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
3
The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH, USA.

Abstract

Measuring clinicians' shared decision-making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries - yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient-reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an assumption of patient awareness of 'decision points' and (ii) an assumption that there is only one decision point in each healthcare consultation. We provide detailed examples of these threats and their impact on accurate assessment of SDM processes and outcomes, which may hamper efforts to introduce incentives for SDM implementation. We propose cognitive interviewing as a recommended method of involving patients in the design of PRMs in the field of SDM and provide a practical example of this approach.

KEYWORDS:

decision making; patient participation; physician-patient relations; psychometrics/instrumentation

PMID:
26111552
PMCID:
PMC5054852
DOI:
10.1111/hex.12380
[Indexed for MEDLINE]
Free PMC Article

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