Do Shared Decision-Making Measures Reflect Key Elements of Shared Decision Making? A Content Review of Coding Schemes

Abstract

Background. There is a growing need for valid shared decision-making (SDM) measures. We aimed to determine whether the items of extant SDM observer-based coding schemes assess the 4 key elements of SDM. Methods. Items of SDM coding schemes were extracted and categorized. Except for the 4 key elements of SDM (fostering choice awareness, informing about options, discussing patient preferences, and making a decision), (sub)categories were created inductively. Two researchers categorized items independently and in duplicate. Results. Five of 12 coding schemes assessed all 4 SDM elements. Seven schemes did not measure “fostering choice awareness,” and 3 did not measure “discussing patient preferences.” Seventy of 194 items (36%) could not be classified into one of the key SDM elements. Items assessing key SDM elements most often assessed “informing about options” (n = 57/124, 46%). Conclusion. Extant SDM coding schemes often do not assess all key SDM elements and have a strong focus on information provision while other crucial elements of SDM are underrepresented. Caution is therefore needed in reporting and interpreting the resulting SDM scores.

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

“…The fact that our RCVC-questions had higher correlations may be due to the fact that both observer and patient addressed the same questions/dimensions. We also note that, in a recent study reviewing the items of validated observer-based instruments of shared decision making, Kunneman et al 13 observed that some validated tools do not assess all key elements of shared decision making while others go beyond these key elements and also assess aspects of health care that are not specific to a particular decision making process (e.g., general communication skills).…”

“…Different models of shared decision making reflect different included dimensions, 5 and measures of shared decision making overlap incompletely with each other. 13 While exploring how/whether the 2 validated tools may be measuring different things, we observed that both tools assess similar but also different shared decision making components (see Appendix 2). However, RCVCpatient and RCVC-observer, which each included the same 2 items, yielded a relatively low correlation, thus supporting the idea that patients may not have the same perspectives of shared decision making processes as external observers do.…”

“…15,27,31,33 Models of shared decision making vary, 5 and the process of shared decision making integrates patients' values, preferences, and perceptions of care in ways that may be complex for external observers to assess. Patient perspectives of a medical decision process often also integrate patient satisfaction with care 13,34 and other important aspects of patient experience that may not be part of the specific decision-making process evaluated by a given observer. 35 Observer ratings of shared decision making, often done by a trained assessor, are supposed to reflect the objective assessment of shared decision making happening in a specific and often single clinical consultation.…”

“…11,12 Observers' perspectives of decision making are helpful to improve the quality of care as they reflect more objective assessment and report the occurrence of core competencies of shared decision making in clinical consultations. 13 The correlation of patient and observer ratings of shared decision making after a clinical consultation has been investigated in some studies. Results suggest that, when observers and patients were asked to rate consultations on the same single measure, observers report less occurrence of shared decision making in clinical consultations as compared to patients.…”

Why do medical residents prefer paternalistic decision making? An interview study

“…The high status placed on scientific evidence in guiding medical decisions may lead to "cookbook medicine", thereby reinforcing to medical students and residents that there is only one way of dealing with a given clinical situation [16,45,46]. We propose that this deeply rooted positivist paradigm in medical science may help to explain the relatively small effects of training physicians in SDM skills on their decisionmaking behavior in subsequent consultations [47][48][49][50][51] or their adoption of the patient perspective [52]. It raises the question of how this positivist professional identity is being shaped in graduate and postgraduate medical education programs, and how an appreciation of the uniqueness of each patient's context, views and preferences can be fostered throughout the medical education continuum.…”