Table 1.

Development process for Decision Quality Instruments

Phase of instrument development	Development steps
1. Identification of key facts and goals	Review clinical evidence and decision making literature. Review literature on patient perspective, and conduct focus groups and interviews with patients and providers. Draft candidate facts and goals across key domains and review with medical experts and decision-making experts. Conduct cross-sectional surveys of patients and providers to assess accuracy, importance, and completeness of candidate facts and goals.
2. Drafting of questions	Draft survey items for key facts and goals. Conduct cognitive testing of survey items with patients. Revise items based on literacy review by expert. Revise items based on medical review by providers. Field test with patients to assess reliability and validity. Refine instruments based on field test results.
3. Validation of instrument	Evaluate performance in diverse samples of patients. Conduct broad-scale review by providers. Review items for accuracy and completeness on annual basis, including patient and provider input as needed.