The quality of instruments to assess the process of shared decision making: A systematic review

Fania R Gärtner, Hanna Bomhof-Roordink, Ian P Smith, Isabelle Scholl, Anne M Stiggelbout, Arwen H Pieterse, Fania R Gärtner, Hanna Bomhof-Roordink, Ian P Smith, Isabelle Scholl, Anne M Stiggelbout, Arwen H Pieterse

Abstract

Objective: To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.

Methods: In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.

Results: We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.

Conclusions: Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.

Conflict of interest statement

Competing Interests: FG, IPS and HB declare that they have no competing interest. IS conducted one physician training in shared decision-making within a research project funded by Mundipharma GmBH (pharmaceutical company) and received travel compensation for this. AP and AS held lectures for pharmaceutical companies (Sanofi en Amgen) for which they received time and travel compensations. To prevent any conflict of interest based co-authorship of articles that were included in this review, members of our research team who were involved in the development and or validation of a specific instrument were not involved in the quality appraisal of these instruments: Isabelle Scholl was involved in the development and validation of the following instruments: SDM-Q-9 [29, 69], SDM-Q-9 (Spanish) [32], SDM-Q-9 (Dutch) [33], SDM-Q-9 Psy (Hebrew) [34], SDM-Q-Doc [35], SDM-Q-Doc (Dutch) [33]. Arwen H. Pieterse was involved in the development and validation of the following instruments: SDM-Q-9 (Dutch) [33], SDM-Q-Doc (Dutch), OPTION12 (Dutch) [56], OPTION5 (Dutch) [55]. Anne M. Stiggelbout was involved in the development and validation of the following instruments: SDM-Q-9 (Dutch) [33], SDM-Q-Doc (Dutch), OPTION12 (Dutch) [56], OPTION5 (Dutch) 56]. There are no patents, products in development, or marketed products to declare. This does not alter the authors’ adherence to all PLOS ONE policies on sharing data and materials. The specific roles of these authors are articulated in the ‘author contributions’ section.

Figures

Fig 1. Flow diagram of article selection…
Fig 1. Flow diagram of article selection process.
Fig 2. Number of included articles and…
Fig 2. Number of included articles and instrument.

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