Gärtner Fania R, Bomhof-Roordink Hanna, Smith Ian P, Scholl Isabelle, Stiggelbout Anne M, Pieterse Arwen H
Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2018 Feb 15;13(2):e0191747. doi: 10.1371/journal.pone.0191747. eCollection 2018.
To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.
In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.
We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.
Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.
对评估共同决策过程的工具进行梳理，并评估其测量质量，同时考虑其验证研究的方法学质量。
在一项系统评价中，我们检索了七个数据库（PubMed、Embase、Emcare、Cochrane、PsycINFO、科学引文索引、学术搜索高级版），以查找调查测量共同决策过程工具的研究。对于每一种确定的工具，我们按照三步程序分别评估10种测量属性的证据水平：1）使用基于共识的健康状况测量工具选择标准（COSMIN）清单评估方法学质量；2）使用三种可能的质量分数评估测量属性的心理测量质量；3）基于研究数量、方法学和心理测量质量以及结果的方向和一致性进行最佳证据综合。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册：CRD42015023397。
我们纳入了51篇描述40种共同决策过程工具的开发和/或评估的文章：16份患者问卷、4份提供者问卷、18种编码方案和2种测量多个视角的工具。总体而言，由于缺少验证或方法不佳，缺乏关于其测量质量的证据。最佳证据综合表明，如果对内容效度（50%）和结构效度（53%）进行评估，大部分工具的结果为阳性，但在评估评分者间信度（47%）和假设检验（59%）时，大部分工具的结果为阴性。
由于缺乏关于测量质量的证据，选择最合适的工具最好基于工具的内容和特征，如它们所评估的视角。我们建议对现有工具进行完善和验证，并使用COSMIN指南来帮助确保高质量的评估。
