Shared decision making: developing the OPTION scale for measuring patient involvement
Shared decision making: developing the OPTION scale for measuring patient involvement
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DOI：
10.1136/qhc.12.2.93
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发表时间：
2003-04-01
影响因子：
--
通讯作者：
Grol, R
中科院分区：
文献类型：
--
作者：
Elwyn, G;Edwards, A;Grol, R
背景资料：一项系统性综述表明，没有措施的程度，医疗保健专业人员涉及患者在决策中的临床consultationsexistence，尽管越来越多的利益或其他患者参与这些decisions.Aims：描述一种新的工具，旨在评估的程度，从业者涉及患者在决策过程中的发展。设计：的选项（观察病人参与）量表是由两个独立的评分员开发和使用，以评估初级保健咨询，以评估其心理测量质量，效度和信度。计算项目反应率、Cronbach's alpha以及OPTION评分总和和缩放。计算项目间和项目-总相关性，并使用Cohen's kappa计算评分者间一致性。采用经典的评分者间组内相关系数和概化理论统计方法计算评分者间信度系数。基于文献综述，定性研究和咨询医生和患者的工具开发确保内容的有效性。结构效度假设检验进行了评估得分变化与患者的年龄，临床主题“平衡”，性别的从业者，并成功的从业者在一个专业examination.Results：OPTION规模提供了可靠的分数检测组之间的差异，在何种程度上，患者参与决策过程中的磋商。研究结果为进一步的实证研究提供了依据。评定者间组内相关系数（0.62）、评定者间一致性的kappa评分（0.71）和Cronbach α（0.79）均高于可接受阈值。基于平衡设计，每位临床医生五次咨询，评价者间信度概化系数为0.68（两名评价者），评价者内信度概化系数为0.66。平均而言，平均从业者的分数是非常相似的（和低的整体规模的可能参与），一些从业者的分数有更多的变化周围的平均值，表明他们不同的沟通方式在更大程度上比others.Conclusions：参与决策是一个关键方面的病人参与医疗保健和OPTION规模提供了一个有效的结果衡量未来的实证研究。
Background: 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.Aims: To describe the development of a new instrument designed to assess the extent to which practitioners involve patients in decision making processes.Design: 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.Study sample: 186 audiotaped consultations collected from the routine clinics of 21 general practitioners in the UK.Method: 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.Results: 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.Conclusions: 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.