August 30, 2019

Reflecting on and making sense of shared decision making

By Kirsten Fleming

Measuring shared decision making (SDM) is challenging. Previous research showed discrepancies between observer-based and self-reported scores. Patient-reported SDM scores are usually higher and tend to have ceiling effects (high scores without much variance), possibly due to halo effects (difficulty to disentangle SDM from overall experience of care).

We wanted to test whether introducing a pause (“stop-and-think”) before filling in SDM scores would slow patients down and encourage them to reflect above and beyond their assessment of general satisfaction with the clinician or the visit. Also, we wanted to assess how much intellectual, emotional, or practical sense the care plan made to patients.

In two studies, we asked a diverse group of patients to reflect on their care before completing the 3-item CollaboRATE SDM measure. In the first study, adding the reflection questions lowered the CollaboRATE score (“less” SDM) and reduced the proportion of patients giving the maximum scores. The differences, while tantalizing in magnitude and direction, were not significant. In the second study, the reflection questions did not change the distribution of CollaboRATE scores or top scores.

In general, patients indicated high scores on the sense of their care plan. However, this ‘sense’ was only weakly correlated with the total CollaboRATE scores. One of every two patients indicated their care plan made less than ideal sense, yet they still gave maximum scores on the CollaboRATE.

Our studies showed limited and somewhat inconsistent evidence that reflection-before-quantification interventions may improve the performance of patient-reported SDM measures. Also, we showed that it is conceivable that scoring high on the “technical steps of SDM” as assessed by SDM measures, may not necessarily lead to a decision that makes sense and vice versa.

The full paper was published in Health Expectations and can be found here.

This study was part of the Fostering Fit by Recognizing Opportunity STudy (FROST) program, and has been made possible by a Mapping the Landscape, Journeying Together grant from the Arnold P. Gold Foundation Research Institute.

Submitted by: Marleen Kunneman, Christina LaVecchia, Naykky Singh Ospina, Abd Moain Abu Dabrh, Emma Behnken, Patrick Wilson, Megan Branda, Ian Hargraves, Kathleen Yost, Richard Frankel, Victor M. Montori

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