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. 2003 Apr;12(2):93–99. doi: 10.1136/qhc.12.2.93

Shared decision making: developing the OPTION scale for measuring patient involvement

G Elwyn 1, A Edwards 1, M Wensing 1, K Hood 1, C Atwell 1, R Grol 1
PMCID: PMC1743691  PMID: 12679504

Abstract

Background: A systematic review has shown that no measures of the extent to which healthcare professionals involve patients in decisions within clinical consultations exist, despite the increasing interest in the benefits or otherwise of patient participation in these decisions.

Aims: To describe the development of a new instrument designed to assess the extent to which practitioners involve patients in decision making processes.

Design: The OPTION (observing patient involvement) scale was developed and used by two independent raters to assess primary care consultations in order to evaluate its psychometric qualities, validity, and reliability.

Study sample: 186 audiotaped consultations collected from the routine clinics of 21 general practitioners in the UK.

Method: Item response rates, Cronbach's alpha, and summed and scaled OPTION scores were calculated. Inter-item and item-total correlations were calculated and inter-rater agreements were calculated using Cohen's kappa. Classical inter-rater intraclass correlation coefficients and generalisability theory statistics were used to calculate inter-rater reliability coefficients. Basing the tool development on literature reviews, qualitative studies and consultations with practitioner and patients ensured content validity. Construct validity hypothesis testing was conducted by assessing score variation with respect to patient age, clinical topic "equipoise", sex of practitioner, and success of practitioners at a professional examination.

Results: The OPTION scale provided reliable scores for detecting differences between groups of consultations in the extent to which patients are involved in decision making processes in consultations. The results justify the use of the scale in further empirical studies. The inter-rater intraclass correlation coefficient (0.62), kappa scores for inter-rater agreement (0.71), and Cronbach's alpha (0.79) were all above acceptable thresholds. Based on a balanced design of five consultations per clinician, the inter-rater reliability generalisability coefficient was 0.68 (two raters) and the intra-rater reliability generalisability coefficient was 0.66. On average, mean practitioner scores were very similar (and low on the overall scale of possible involvement); some practitioner scores had more variation around the mean, indicating that they varied their communication styles to a greater extent than others.

Conclusions: Involvement in decision making is a key facet of patient participation in health care and the OPTION scale provides a validated outcome measure for future empirical studies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barry C. A., Bradley C. P., Britten N., Stevenson F. A., Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000 May 6;320(7244):1246–1250. doi: 10.1136/bmj.320.7244.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Benbassat J., Pilpel D., Tidhar M. Patients' preferences for participation in clinical decision making: a review of published surveys. Behav Med. 1998 Summer;24(2):81–88. doi: 10.1080/08964289809596384. [DOI] [PubMed] [Google Scholar]
  3. Boon H., Stewart M. Patient-physician communication assessment instruments: 1986 to 1996 in review. Patient Educ Couns. 1998 Nov;35(3):161–176. doi: 10.1016/s0738-3991(98)00063-9. [DOI] [PubMed] [Google Scholar]
  4. Braddock C. H., 3rd, Fihn S. D., Levinson W., Jonsen A. R., Pearlman R. A. How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting. J Gen Intern Med. 1997 Jun;12(6):339–345. doi: 10.1046/j.1525-1497.1997.00057.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Charles C., Gafni A., Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med. 1999 Sep;49(5):651–661. doi: 10.1016/s0277-9536(99)00145-8. [DOI] [PubMed] [Google Scholar]
  6. Charles C., Gafni A., Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997 Mar;44(5):681–692. doi: 10.1016/s0277-9536(96)00221-3. [DOI] [PubMed] [Google Scholar]
  7. Coulter A. Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy. 1997 Apr;2(2):112–121. doi: 10.1177/135581969700200209. [DOI] [PubMed] [Google Scholar]
  8. Edwards A., Elwyn G., Smith C., Williams S., Thornton H. Consumers' views of quality in the consultation and their relevance to 'shared decision-making' approaches. Health Expect. 2001 Sep;4(3):151–161. doi: 10.1046/j.1369-6513.2001.00116.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Elwyn G., Edwards A., Gwyn R., Grol R. Towards a feasible model for shared decision making: focus group study with general practice registrars. BMJ. 1999 Sep 18;319(7212):753–756. doi: 10.1136/bmj.319.7212.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Elwyn G., Edwards A., Kinnersley P., Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract. 2000 Nov;50(460):892–899. [PMC free article] [PubMed] [Google Scholar]
  11. Elwyn G., Edwards A., Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999 Jun;49(443):477–482. [PMC free article] [PubMed] [Google Scholar]
  12. Elwyn G., Edwards A., Mowle S., Wensing M., Wilkinson C., Kinnersley P., Grol R. Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Educ Couns. 2001 Apr;43(1):5–22. doi: 10.1016/s0738-3991(00)00149-x. [DOI] [PubMed] [Google Scholar]
  13. Elwyn G., Edwards A., Wensing M., Hibbs R., Wilkinson C., Grol R. Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. J Eval Clin Pract. 2001 May;7(2):211–221. doi: 10.1046/j.1365-2753.2001.00286.x. [DOI] [PubMed] [Google Scholar]
  14. Elwyn Glyn, Gwyn Richard, Edwards Adrian, Grol Richard. Is 'shared decision-making' feasible in consultations for upper respiratory tract infections? Assessing the influence of antibiotic expectations using discourse analysis. Health Expect. 1999 May;2(2):105–117. doi: 10.1046/j.1369-6513.1999.00045.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Guadagnoli E., Ward P. Patient participation in decision-making. Soc Sci Med. 1998 Aug;47(3):329–339. doi: 10.1016/s0277-9536(98)00059-8. [DOI] [PubMed] [Google Scholar]
  16. Gwyn R., Elwyn G. When is a shared decision not (quite) a shared decision? Negotiating preferences in a general practice encounter. Soc Sci Med. 1999 Aug;49(4):437–447. doi: 10.1016/s0277-9536(99)00067-2. [DOI] [PubMed] [Google Scholar]
  17. Hall J. A., Irish J. T., Roter D. L., Ehrlich C. M., Miller L. H. Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. Health Psychol. 1994 Sep;13(5):384–392. doi: 10.1037//0278-6133.13.5.384. [DOI] [PubMed] [Google Scholar]
  18. Kerry S. M., Bland J. M. The intracluster correlation coefficient in cluster randomisation. BMJ. 1998 May 9;316(7142):1455–1455. doi: 10.1136/bmj.316.7142.1455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kurtz S. M., Silverman J. D. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ. 1996 Mar;30(2):83–89. doi: 10.1111/j.1365-2923.1996.tb00724.x. [DOI] [PubMed] [Google Scholar]
  20. Little P., Everitt H., Williamson I., Warner G., Moore M., Gould C., Ferrier K., Payne S. Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ. 2001 Feb 24;322(7284):468–472. doi: 10.1136/bmj.322.7284.468. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Marvel M. K., Schilling R., Doherty W. J., Baird M. A. Levels of physician involvement with patients and their families. A model for teaching and research. J Fam Pract. 1994 Dec;39(6):535–544. [PubMed] [Google Scholar]
  22. Mead N., Bower P. Measuring patient-centredness: a comparison of three observation-based instruments. Patient Educ Couns. 2000 Jan;39(1):71–80. doi: 10.1016/s0738-3991(99)00092-0. [DOI] [PubMed] [Google Scholar]
  23. Mead N., Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000 Oct;51(7):1087–1110. doi: 10.1016/s0277-9536(00)00098-8. [DOI] [PubMed] [Google Scholar]
  24. O'Connor A. M., Rostom A., Fiset V., Tetroe J., Entwistle V., Llewellyn-Thomas H., Holmes-Rovner M., Barry M., Jones J. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ. 1999 Sep 18;319(7212):731–734. doi: 10.1136/bmj.319.7212.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Skelton J. R., Hobbs F. D. Descriptive study of cooperative language in primary care consultations by male and female doctors. BMJ. 1999 Feb 27;318(7183):576–579. doi: 10.1136/bmj.318.7183.576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Stevenson F. A., Barry C. A., Britten N., Barber N., Bradley C. P. Doctor-patient communication about drugs: the evidence for shared decision making. Soc Sci Med. 2000 Mar;50(6):829–840. doi: 10.1016/s0277-9536(99)00376-7. [DOI] [PubMed] [Google Scholar]
  27. Stewart M. Towards a global definition of patient centred care. BMJ. 2001 Feb 24;322(7284):444–445. doi: 10.1136/bmj.322.7284.444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. van Thiel J., Kraan H. F., Van Der Vleuten C. P. Reliability and feasibility of measuring medical interviewing skills: the revised Maastricht History-Taking and Advice Checklist. Med Educ. 1991 May;25(3):224–229. doi: 10.1111/j.1365-2923.1991.tb00055.x. [DOI] [PubMed] [Google Scholar]

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