Gattellari Melina, Ward Jeanette E
School of Public Health and Community Medicine, Department of General Practice, The University of New South Wales, and Division of Population Health, South-western Sydney Area Health Service, Liverpool, Australia.
J Eval Clin Pract. 2005 Jun;11(3):237-46. doi: 10.1111/j.1365-2753.2005.00530.x.
RATIONALE, AIMS AND OBJECTIVES: Now that active involvement by patients in their health care is widely endorsed, valid and reliable methods for determining preferences for involvement in treatment decision making are essential. Relatively little methodological work has been conducted to compare and contrast their reliability and validity. Available single-item measures exist to determine preferences, ranging from 'menu-based' questions to simpler Likert-type scales.
Within a larger community survey of 514 men aged 50-70 years in Sydney, Australia, we compared two measures to assess their preferences for involvement in medical decision making. Using the 'menu-based' Control Preference Scale (CPS), men were classified as preferring to be either 'passive' or 'active' during decision making or to share ('shared') with their doctors on an equal basis. Men also were classified as preferring to be either 'passive' or 'active' according to a Likert-scale measure.
Agreement between the two measures was 'poor' (kappa=0.19). While 24.9% of participants were classified as preferring a 'passive' role in treatment decision making according to the CPS, almost half (47.9%) were so classified according to Arora and McHorney's measure. In the absence of a 'shared' response option on the Arora and McHorney measure, 45.3% of men classified as preferring a 'shared role' on the CPS were instead categorized as 'passive' using Arora and McHorney's measure. Predictors of preferring a 'passive' role also differed, depending on the measure employed. Only occupational skill level predicted men's preferences for a 'passive' role when measured by the CPS [odds ratio (OR)=1.67; 95% CI 1.09-2.55] (P=0.02). For the Arora and McHorney's measure of preferences for involvement, men were significantly more likely to prefer a 'passive' role if they were older [adjusted odds ratio (AOR)=1.06, 95% CI 1.02-1.09] (P=0.001), currently smoking (AOR=1.86, 95% CI 1.09-3.17) (P=0.02) and had higher chance health locus of control scores (AOR=1.26; 95% CI 1.01-1.56) (P=0.04). Having been employed or previously employed in an occupation of a lower skill level was also significantly and independently predictive of a passive role (AOR=2.35, 95% CI 1.57-3.50) (P<0.001).
Single-item measures of decisional preferences have poor convergent validity. Characteristics associated with preference classifications also differ, depending upon the measures used. These results suggest that research efforts should be directed towards developing psychometrically robust measures to determine decisional preferences.
原理、目的和目标：既然患者积极参与自身医疗保健已得到广泛认可，那么用于确定参与治疗决策偏好的有效且可靠的方法至关重要。为比较和对比这些方法的可靠性与有效性所开展的方法学研究相对较少。现有的单项测量方法可用于确定偏好，从“基于菜单”的问题到更简单的李克特量表不等。
在澳大利亚悉尼对514名年龄在50至70岁之间的男性进行的一项更大规模社区调查中，我们比较了两种评估他们参与医疗决策偏好的方法。使用“基于菜单”的控制偏好量表（CPS），男性被分类为在决策过程中倾向于“被动”或“主动”，或者与医生平等“共享”决策权。男性也根据李克特量表测量被分类为倾向于“被动”或“主动”。
两种测量方法之间的一致性“较差”（kappa = 0.19）。根据CPS，24.9%的参与者被分类为在治疗决策中倾向于“被动”角色，而根据阿罗拉和麦克霍尼的测量方法，几乎一半（47.9%）的参与者被如此分类。由于阿罗拉和麦克霍尼的测量方法没有“共享”的回答选项，在CPS上被分类为倾向于“共享角色”的男性中，有45.3%使用阿罗拉和麦克霍尼的测量方法被归类为“被动”。倾向于“被动”角色的预测因素也因所采用的测量方法而异。当用CPS测量时，只有职业技能水平能预测男性对“被动”角色的偏好[优势比（OR）=1.67；95%置信区间1.09 - 2.55]（P = 0.02）。对于阿罗拉和麦克霍尼的参与偏好测量方法，如果男性年龄较大[调整后优势比（AOR）=1.06，95%置信区间1.02 - 1.09]（P = 0.001）、目前吸烟（AOR = 1.86, 95%置信区间1.09 - 3.17）（P = 0.02）且健康控制点得分较高（AOR = 1.26；95%置信区间1.01 - 1.56）（P = 0.04），他们更有可能倾向于“被动”角色。曾从事或以前从事技能水平较低职业也显著且独立地预测了被动角色（AOR = 2.35, 95%置信区间1.57 - 3.50）（P < 0.001）。
决策偏好的单项测量方法具有较差的收敛效度。与偏好分类相关的特征也因所使用的测量方法而异。这些结果表明，研究工作应致力于开发心理测量学上稳健的测量方法来确定决策偏好。
