Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
Research Centre of the CHU de Québec, Laval University, Quebec City, QC, Canada.
Med Decis Making. 2021 Jan;41(1):51-59. doi: 10.1177/0272989X20977885.
Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients' and observers' ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations.
In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item "observing patient involvement" score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient).
Agreement was low between observers' and patients' ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; = 0.38). Observers' ratings using RCVC-observer were correlated to patients' ratings using either SDM-Q9 ( = -0.16; = 0.01) or RCVC-patients ( = 0.24; = 0.03). Observers' OPTION-5 scores and patients' ratings using RCVC-questions were moderately correlated ( = 0.33; = 0.04).
There was moderate to no alignment between observers' and patients' ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.
在临床实践中测量共享决策（SDM）对于提高医疗质量非常重要。测量可以由经过培训的观察者和参与临床就诊的人员（即患者）进行。本研究旨在使用 2 种经过验证和 2 种未经验证的 SDM 测量工具，描述患者和观察者对 SDM 的评分之间的相关性，这些工具用于临床咨询。
在这项横断面研究中，我们在加拿大 5 家大学附属医院的家庭医学诊所招募了 238 对完整的医患二人组。参与者在接受录音医疗咨询前后完成了自我管理的问卷调查。观察者使用经过验证的 OPTION-5（5 项“观察患者参与度”评分）和关于风险沟通和价值观澄清的二项式问题（RCVC-观察者），对医疗咨询期间 SDM 的发生情况进行评分。患者使用 9 项共享决策调查问卷（SDM-Q9）和关于风险沟通和价值观澄清的二项式问题（RCVC-患者）对 SDM 进行评分。
观察者和患者分别使用经过验证的 OPTION-5 和 SDM-Q9 对 SDM 的评分之间的一致性较低（ρ=0.07； =0.38）。观察者使用 RCVC-观察者的评分与患者使用 SDM-Q9（ =-0.16； =0.01）或 RCVC-患者（ =0.24； =0.03）的评分相关。观察者的 OPTION-5 评分和患者使用 RCVC-问题的评分中度相关（ =0.33； =0.04）。
使用经过验证和未经验证的工具，观察者和患者对 SDM 的评分之间存在中等至无一致性。这种缺乏强相关性强调了观察者和患者的观点是不可互换的。在评估 SDM 的存在、不存在或程度时，重要的是要清楚地说明反映了谁的观点。
