Patient involvement and person-centered medicine in cardiovascular prevention: Modelling the items of the OPTION instrument on process steps of shared decision-making

Article Sidebar

Requires Subscription or Fee PDF (USD 25)
Published: Jun 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i2.80

Main Article Content

Heidemarie Keller
Department of General Practice, Philipps University of Marburg, Germany
Oliver Hirsch
Department of General Practice, Philipps University of Marburg, Germany
Meike Müller-Engelmann
Department of General Practice, Philipps University of Marburg, Germany
Monika Heinzel-Gutenbrunner
Department of General Practice, Philipps University of Marburg, Germany
Norbert Donner-Banzhoff
Philipps University of Marburg, Germany
Tanja Krones
University Hospital Zurich & Institute of Biomedical Ethics, University of Zurich, Switzerland; Department of General Practice, Philipps University of Marburg, Germany

Abstract

Rationale, aims and objectives: In cardiovascular prevention within primary care, there is a lack of empirical information about how patients are involved in decision-making processes. Our research aim in the present study was to model the delineated items of the OPTION instrument on theoretical shared decision-making process steps in order to investigate how physicians’ competences correspond to the defined process steps as reported in the literature. Method:  We tested the adequacy of a theoretical model which links certain items of the original OPTION instrument to specific steps of the shared decision making process and validated our model by the inclusion of the expert consensus ratings where different shared decision-making steps took place.Design: Cross-sectional assessment of physician-patient interaction by two rater pairs using a cross-over design and additional rating of two experts in shared decision making (SDM). The study sample consisted of 15 general practitioners who provided 40 videotaped consultations.Results: We found support for our theoretical model when linking items of the OPTION instrument to steps of the shared decision-making process. The validation of our model using expert consensus ratings resulted in only a partial support for our model.Conclusions: Our research provides insight into some of the dilemmas in measuring shared decision-making. On the one hand, these measures provide evidence as to which key elements of shared decision-making are likely to be presented in a consultation and those which may be more problematic in practice. Equally, it may be that we need to recognise the limitations of measurement and its ability to capture the full complexity of the shared decision-making process.

Article Details

Issue
Vol. 1 No. 2 (2011): June
Section
Regular Articles
Author Biographies

Heidemarie Keller, Department of General Practice, Philipps University of Marburg, Germany

Senior Lecturer & Research Fellow, Department of General Practice, Philipps University of Marburg, Germany

Norbert Donner-Banzhoff, Philipps University of Marburg, Germany

Professor and Head of Department of General Practice

Tanja Krones, University Hospital Zurich & Institute of Biomedical Ethics, University of Zurich, Switzerland; Department of General Practice, Philipps University of Marburg, Germany

Professor and Head of Clinical Ethics

References

. Charles, C.A, Whelan, T., Gafni, A., Willan, A. and Farrell, S. (2003). Shared treatment decision-making: what does it mean to physicians? Journal of Clinical Oncology 21, 932–936.

. Charles, C., Gafni, A. and Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science and Medicine 44, 681–692.

. Elwyn, G., Edwards, A., Mowle, S., Wensing, M., Wilkinson, C., Kinnersley, P. and Grol, R. (2001). Measuring the involvement of patients in shared decision-making: a systematic review of instruments. Patient Education and Counseling 43, 5–22.

. Elwyn, G., Edwards, A., Wensing, M., Hibbs, R., Wilkinson, C. and Grol, R. (2001). Shared decision making observed in clinical practice: visual displays of communication sequence and patterns. Journal of Evaluation in Clinical Practice 7, 211–221.

. Makoul, G. and Clayman, M.L. (2006). An integrative model of shared decision making in medical encounters. Patient Education and Counseling 60(3), 301-312.

. O'Connor, A.M, Bennett, C.L., Stacey, D., Barry, M., Col, N.F., Eden, K.B., Entwistle, V. A., Fiset, V., Holmes-Rovner, M., Khangura, S., Llewellyn-Thomas, H. and Rovner, D. (2009). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 3

. Elwyn, G., Edwards, A., Wensing, M., Hood, K., Atwell, C. and Grol, R. (2003). Shared decision-making: developing the OPTION scale for measuring patient involvement. Quality and Safety in Health Care 12(2), 93-99.

. Elwyn, G., Hutchings, H., Edwards, A., Rapport, F., Wensing, M., Cheung, WY. et al (2005). The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expectations 8(1), 34-42.

. Hirsch, O., Keller, H., Müller-Engelmann, M., Heinzel-Gutenbrunner, M., Krones, T. and Donner-Banzhoff, N. (2011). Reliability and validity of the German version of the OPTION scale. Health Expectations DOI 10.1111/j.1369-7625.2011.00689.x.

. Elwyn, G., O’Connor, A.M., Stacey, D., Volk, R., Edwards, A. and Coulter, A. (2006). Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. British Medical Journal 333(7565), 417-423.

. Krones, T., Keller, H., Soennichsen, A., Sadowski,

E.M., Baum, E., Wegscheider, K. et al. (2008). Absolute cardiovascular disease risk and shared decision making in primary care: A randomized controlled trial. Annals of Family Medicine 6(3), 218-227.

. Keller, H., Hirsch, O., Müller-Engelmann, M., Heinzel-Gutenbrunner, M., Krones, T. and Donner-Banzhoff, N. (2011). Reliability and validity of a modified German version of the OPTION scale. Annals of Family Medicine under review.

. Weiber, R. and Mühlhaus, D. (2010). Strukturgleichungsmodellierung [Structural equation modeling]. Heidelberg: Springer.

. Ringle, C.M., Wende, S. and Will, S. (2005). SmartPLS 2.0 (M3) Beta. Hamburg: University of Hamburg.

. Howell, D.C. (2009). Statistical methods for psychology. Florence: Cengage Learning Services.

. Schendera CFG. (2008). Regressionsanalyse mit SPSS [Regression analysis with SPSS]. Munich: Oldenbourg.

. Fornell, C. and Larker, D.F. (1981). Evaluation of structural equation models with unobservable variables and measurement error. Journal of Marketing Research 18, 39-50.

. Bagozzi, R.P. and Yi, Y. (1988). On the evaluation of structural equation models. Journal of the Academy of Marketing Science 16, 74-94.

. Tabachnick, B.G. and Fidell, L.S. (2007). Using multivariate statistics. London: Pearson.

. Stacey, D., Legare, F., Pouliot, S., Kryworuchko, J. and Dunn, S. (2010). Shared decision- making models to inform an interprofessional perspective on decision making: A theory analysis. Patient Education and Counseling 80(2), 164-172.

. Edwards, M., Davies, M. and Edwards A. (2009). What are the external influences on information exchange and shared decision-making in healthcare consultations: a meta-synthesis of the literature. Patient Education and Counseling 75, 37–52.