Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure

Abstract

Background The Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical decision. SDM Process items have been used previously in studies of surgical decision making and exhibited discriminant and construct validity. Method Secondary data analysis was conducted across 8 studies of 11 surgical conditions with 3965 responses. Each study contained SDM Process items that assessed the discussion of options, pros and cons, and preferences. Item wording, content, and number of items varied, as did inclusion of measures assessing decision quality, decisional conflict (SURE scale), and regret. Several approaches for scoring, weighting, and the number of items were compared to identify an optimal approach. Optimal SDM Process scores were compared with measures of decision quality, conflict, and regret to examine construct validity; meta-analysis generated summary results. Results Although all versions of the scale were highly correlated, a short, partial credit, equally weighted version of the scale showed favorable properties. Overall, higher SDM Process scores were related to higher decision quality ( d = 0.18, P = 0.029), higher SURE scale scores ( d = 0.57, P < 0.001), and lower decision regret ( d = −0.34, P < 0.001). Significant heterogeneity was present in all validity analyses. Limitations Included studies all focused on surgical decisions, several had small sample sizes, and many were retrospective. Conclusion SDM Process scores showed resilience to coding changes, and a scheme using the short, partial credit, with equal weights was adopted. The SDM Process scores demonstrated a small, positive relationship with decision quality and were consistently related to lower decision conflict and less regret, providing evidence of validity across several surgical decisions.

Impact of the shared decision‐making process on lung cancer screening decisions

“…Previous studies have already tested the SDMP_4 in other clinical settings (e.g., surgery decisions) and found it to be a robust measure. 23 To the best of our knowledge, this study is the first to test the SDMP_4 for screening decisions, specifically LCS, further supporting the use of this measure across diverse medical contexts and patient populations. Future research should continue to test the SDMP_4 in a variety of settings to move toward a consistent measure of SDM quality.…”

“…In all other analyses, T0 measures (baseline) were used and the data were examined cross‐sectionally. The SDM process scores were analyzed in two ways: (1) summed up to create a composite score ranging from 0 to 4, with higher scores indicating better quality of the SDM process, 16 and (2) each of the four items used individually in the analyses to assess the individual impact of the conceptually distinct 23 aspects of the SDM process on our outcomes. Covariates were determined a priori by entering gender and education level into a regression model with the outcome variables.…”

Using Standardized Videos to Examine the Validity of the Shared Decision Making Process Scale: Results of a Randomized Online Experiment

“…Compared to our prior validation study on surgical decisions, the mean scores for the poor-quality high cholesterol, good-quality high cholesterol, and poor-quality colorectal cancer screening all surpass the maximum scores identified prior. 9 This finding may be due to the fact that these individuals are rating videos contrived to present SDM, and individuals were not asked to rate real interactions they had with health care providers. Furthermore, these measures were adaptations of their original scales.…”

“…The SDM Process scale has since been tested extensively, finding the scale to be robust to scoring variation and providing evidence of the scale’s validity in surgical decision contexts. 9 The SDM Process scale has also demonstrated the ability to distinguish between those who had been given formal decision support and those who had not in surgical decisions. 4 However, evidence of this type of validity has not yet been demonstrated for cancer screening or medication decisions.…”

Real-world patient data: Can they support decision making and patient engagement?

“…Various instruments have also been developed to capture and evaluate the SDM process, including the understanding and attainment of knowledge, elicitation and consolidation of preferences, decision quality, decision conflict, and decision regret [ 63 , 64 ]. Examples are the Shared Decision Making Process scale [65] , Knee Decision Quality Instrument [66] , and CollaboRATE survey [67] . Evaluating SDM is important to understand how a high-quality decision can be achieved between clinicians and patients, which factors promote it, and how it can improve patient outcomes.…”