Shared decision making: The reliability of the OPTION scale in Italy

https://doi.org/10.1016/j.pec.2007.01.002Get rights and content

Abstract

Objective

To provide psychometric characteristics of the Italian language version of the OPTION scale and descriptive statistics on patients’ involvement. The OPTION scale assesses the extent to which clinicians involve patients in therapeutic decisions. The English language version has a Cohen's κ score for individual items ranging from 0.45 to 0.98 and an intraclass correlation coefficient (ICC) for the total score of 0.77.

Methods

Six male GPs provided 235 audiotaped consultations with consecutive patients who had attended for a new illness episode over a 2-month period. Thirty interviews were rated by two raters to assess inter- and intra rater as well as test–retest reliability of the Italian language version of the OPTION scale. Based on the whole sample, Cronbach's α and an exploratory factor analysis were performed to assess internal validity and to determine factor loadings.

Results

Cohen's κ values were comprised between 0.29 and 0.73, the ICC at test and retest was 0.85 and 0.81 and Cronbach's α 0.82. The ratings for each OPTION item showed a skewed distribution: the majority of scores (>70%) were between 0 (behaviour absent) and 2 (minimum skill level).

Conclusion

The reliability indices were satisfactory and similar to those reported for the original OPTION.

Practice implications

OPTION can be used for both teaching purposes and research, as well as for future cross-national comparisons.

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.

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