Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R
Department of Primary Care, University of Wales Swansea Clinical School, Swansea SA2 8PP, UK.
Qual Saf Health Care. 2003 Apr;12(2):93-9. doi: 10.1136/qhc.12.2.93.
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.
To describe the development of a new instrument designed to assess the extent to which practitioners involve patients in decision making processes.
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.
186 audiotaped consultations collected from the routine clinics of 21 general practitioners in the UK.
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.
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.
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.
一项系统评价表明，尽管人们对患者参与临床会诊决策的益处越来越感兴趣，但目前尚无衡量医疗保健专业人员在临床会诊中让患者参与决策程度的方法。
描述一种旨在评估从业者让患者参与决策过程程度的新工具的开发情况。
开发了OPTION（观察患者参与度）量表，并由两名独立评分者用于评估初级保健会诊，以评估其心理测量学特性、有效性和可靠性。
从英国21名全科医生的常规诊所收集的186份录音会诊。
计算项目反应率、克朗巴哈系数以及汇总和标准化的OPTION分数。计算项目间和项目与总分的相关性，并使用科恩kappa系数计算评分者间的一致性。使用经典的评分者间组内相关系数和概化理论统计量来计算评分者间的可靠性系数。基于文献综述、定性研究以及与从业者和患者的咨询来开发该工具，确保了内容效度。通过评估患者年龄、临床主题“ equipoise”、从业者性别以及从业者在专业考试中的成绩等方面的得分差异，进行了结构效度假设检验。
OPTION量表为检测不同会诊组在患者参与会诊决策过程程度方面的差异提供了可靠的分数。结果证明该量表可用于进一步的实证研究。评分者间组内相关系数（0.62）、评分者间一致性的kappa分数（0.71）和克朗巴哈系数（0.79）均高于可接受阈值。基于每位临床医生平均五次会诊的均衡设计，评分者间可靠性概化系数为0.68（两名评分者），评分者内可靠性概化系数为0.66。平均而言，从业者的平均得分非常相似（在可能参与的总体量表上较低）；一些从业者的得分在平均值周围的变化更大，表明他们的沟通方式比其他人有更大的差异。
参与决策是患者参与医疗保健的一个关键方面，OPTION量表为未来的实证研究提供了一种经过验证的结果测量方法。
