Shared decision making: The reliability of the OPTION scale in Italy☆
Introduction
The active collaboration between doctor and patient has been recently encouraged through the shared decision making model [1], [2]. Several studies have been conducted to assess the importance of this approach [3], [4] and to evaluate patient's preferences [5]. It was shown also that clinicians can learn the skills, which promote greater patient involvement in health care decision making [6]. However, what really happens during consultations has not been definitely established. Some studies have analyzed the information giving process as the first step towards a shared decision. Lee and Garvin [7] commented that the information process is more an information transfer (based on a one-way monologue) than an information exchange (based on two-way dialogue). A recent study using the method of sequence analysis [8] has shown a low frequency of patient expressions of opinions and questions immediately before and after General Practitioners’ (GPs) gave information, and a lack of facilitating questions by GPs, indicating a limited degree of patient involvement in the consultation [9].
The debate about how and when to encourage patients to participate in decisions about their care and about what are the most appropriate tools and outcome measures to evaluate the process is still open [10]. Instruments for measuring patient involvement are few as revealed in a recent review of the literature [11]. Elwyn et al. [12] have developed a scale called OPTION (acronym for “observing patient involvement”) which assesses the extent to which clinicians involve patients in decisions across a range of situations in clinical practice. The OPTION scale was developed inductively using qualitative studies of the skills that practitioners perceive are required in order to ‘involve patients in decision making processes’, based in turn on the conceptual framework of ‘shared decision making’. It has been used to date in both observational and intervention studies [6], [12], [13], [14], [15].
Aim of the present study was to provide reliability and validity data of the Italian language version of the OPTION scale and descriptive statistics on how Italian GPs involve their patients in the decision making process.
Section snippets
OPTION scale
The instrument is 12 item five-point scale (from 0 (behaviour not observed) to 4 (high standard)), for which κ scores between 0.45 and 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77 has been reported [12], [13] (see Appendix A for the scale used in this study). The raw total score ranges from 0 (0 level in all items) to 48 (four level in all items). A score of 2 equates to the observation of minimal skills level and a score of 24 would indicate that global
Patients characteristics
The present study uses a database from a previous study [23], [24]. The sample consisted of 238 consecutive patients (aged between 16 and 74) who over a 2-month period in 1996 had seen a GP for a new illness episode. The patients had consented to be audiotaped and to the use of their anonymous transcribed consultations for any further research purposes. Ten patients refused to participate and were substituted. Due to technical problems or poor quality of the audio 235 completed transcripts of
Discussion
The Italian language version of OPTION showed a satisfactory inter-rater reliability although the κ scores and ICC for the single items were somewhat lower than those reported by Elwyn et al. [12]. The ICC on total score was higher in the Italian version. The Italian OPTION demonstrated to be stable over time within and between rater(s) and to possess a good internal validity, with Cronbach's α slightly higher than that reported by Elwyn et al. [12], [13].
Further comparisons with the findings
Declaration of interest
None.
References (30)
- et al.
Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model
Soc Sci Med
(1999) - et al.
Moving from information transfer to information exchange in health and health care
Soc Sci Med
(2003) - et al.
Measuring the involvement of patients in shared decision-making: a systematic review of instruments
Patient Educ Couns
(2001) - et al.
The assessment of depressive patients’ involvement in decision making in audio taped primary care consultations
Patient Educ Couns
(2006) General practitioners views on shared decision making: a qualitative analysis
Patient Educ Couns
(2003)- et al.
Informed decision making in outpatient practice: time to get back to basics
J Am Med Assoc
(1999) Partnerships with patients: the pros and cons of shared clinical decision-making
J Health Serv Res Policy
(1997)- et al.
Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices
Br J Gen Pract
(2000) - et al.
The role of doctor's opinion in shared decision making: what does shared decision making really mean when considering invasive medical procedures?
Health Expect
(2005) - et al.
Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice
Fam Pract
(2004)
Event-based categorical sequential analyses of the medical interview: a review
Epidemiol Psichiatr Soc
Information-giving sequences in general practice consultations
J Eval Clin Pract
Shared decision-making: the debate continues
Health Expect
Shared decision making: developing the OPTION scale for measuring patient involvement
Qual Saf Health Care
The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks
Health Expect
Cited by (46)
Bringing personal perspective elicitation to the heart of shared decision-making: A scoping review
2022, Patient Education and CounselingCitation Excerpt :Fig. 2 presents the median Observer OPTION 5 (part a) and Observer OPTION 12 (part b) scores with the PPE-related items highlighted. The PPE-related items were among the lowest scoring items: the median score on item 4 of the Observer OPTION 5 was 1.0 (interquartile range, IQR: 0.7–1.6) based on 15 mean scores from 10 studies (upper graph Fig. 2) [26–35]; the median score on item 7 of the Observer OPTION 12 was 0.8 (IQR: 0.4–1.1) based on 25 mean scores from 22 studies (lower graph Fig. 2) [33,40–60]. Fourteen studies used SDM instruments other than the Observer OPTION (see Supplementary file - Appendix C Table C2 for an explanation of the scoring systems and outcomes).
Where are we in shared decision-making in Italy? A brief updated review
2022, Zeitschrift fur Evidenz, Fortbildung und Qualitat im GesundheitswesenThe Chinese version of OPTION scale: Is it reliable on measuring the shared decision-making among preoperative conversations
2021, Patient Education and CounselingCitation Excerpt :We only conducted the reliability test for the OPTION12-C in this pilot study. We did not conduct the validity test with two major considerations: (1) we planned to run a confirmatory factor analysis with a larger sample size in our next-step study in order to obtain an acceptable validity results; (2) [11–13,21] we did not find any suitable Chinese SDM scale to be used as criterion. As a retrospective study, there were some information missed especially for the participants of patients and family members.
Shared decision-making for delivery mode: An OPTION scale observer-based evaluation
2019, Patient Education and CounselingCitation Excerpt :The OPTION12 scale may prove useful to test the extent of pregnant women’s involvement in deciding between CD and VD. Although the use of the OPTION12 scale for training purposes is still controversial [28,52] the knowledge of the patient’s low level of involvement seems mandatory to promote the development of training programs to improve SDM skills. The awareness of a low patients’ involvement requires a comprehensive strategy to promote SDM in clinical practice including not only education and training, but also the availability of validated decision aids SDM, that will require careful consideration from both clinicians and patients [23], may lead also to medico-legal protection.
- ☆
I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.