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Communication
Research
Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
  1. Denitza Williams1,
  2. Adrian Edwards1,
  3. Fiona Wood1,
  4. Amy Lloyd2,
  5. Kate Brain1,
  6. Nerys Thomas3,
  7. Alison Prichard3,
  8. Annwen Goodland3,
  9. Helen Sweetland4,
  10. Helen McGarrigle4,
  11. Gwenllian Hill5,
  12. Natalie Joseph-Williams1
  1. 1 Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
  2. 2 Centre for Trials Research, Cardiff University, Cardiff, UK
  3. 3 Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
  4. 4 Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
  5. 5 Patient and Public Representative, Cardiff, UK
  1. Correspondence to Dr Denitza Williams; stoilovado{at}cf.ac.uk

Abstract

Objectives To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations.

Design Multi-method study using observational and self-reported measures of SDM and qualitative analysis.

Setting Breast care and predialysis teams who had already implemented SDM.

Participants Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions.

Methods Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure.

Results Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were ‘incorporating patient preferences into decisions’ for the breast team (mean 18.5, range 12.5–20, SD 2.39) and ‘eliciting patient preferences to options’ for the renal team (mean 16.15, range 10–20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions.

Conclusions Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.

  • shared decision-making
  • measurement
  • OPTION-5
  • qualitative research
  • patient-centred care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-029485

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    Footnotes

    • Contributors DW drafted the manuscript. AE, FW, KB, NJW and AL conceived the study and its design. NT, AP, AG, HMcG and HS facilitated the study recruitment. NJW, AL and DW led acquisition of study data. DW and NJW conducted qualitative and quantitative analyses. NJW, DW, AE, FW and GH led data interpretation. All authors worked collaboratively to contribute to the content, to edit and to agree the final version of the manuscript.This paper originated from the ‘Understanding the shared decision-making encounter: a mixed-methods evaluation of patients’ and clinicians’ experiences’ project funded by the Health Foundation. The project involved collaboration with Cardiff and Vale University Health Board and Cardiff University. The learning is based on the involvement of the breast cancer care and chronic kidney disease teams and patient and public involvement.

    • Funding This work was funded by the Health Foundation (Ref 7212) and was sponsored by Cardiff University.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study and associated protocol received favourable ethical approval from the Wales Research Ethical Committee 1 (14, WA/0036) and further relevant approvals were received from the Cardiff and Vale University Health Board (ID 14/CMC/5842).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.