DEVELOPING A THEORY-BASED MEASURE OF PATIENT SHARED DECISION MAKING COMMUNICATION BEHAVIORS

Purpose: Decision support interventions (DESIs) have been described as adjuncts to clinical consultations and facilitators of shared decision-making (SDM). To date, there are few measures to assess their impact on patient communication behaviors. The goal of this study was to develop a theory-based self-report measure to enable research on the impact of DESIs on patient communication behaviors.

Method: Development was informed by Fishbein and Ajzen’s Reasoned Action Approach. Using this theoretical frame we conducted focus groups with patients (N=48) to identify their salient beliefs related to engaging in 3 key SDM communication behaviors: (1) asking questions, (2) discussing preferences and (3) disagreeing with a recommendation. We drafted survey items to assess the identified salient beliefs and the central constructs (attitudes, perceived social norms, self-efficacy and behavioral intention) of the Reasoned Action Approach for SDM communication behaviors.  The draft survey items were iteratively tested and refined through cognitive interviews with a new set of participants (N=10). Finally, we fielded the survey to a large sample of respondents (N=1,340) who first read a hypothetical preference sensitive clinical scenario and then answered the survey questions related to engaging in SDM communication behaviors. The survey data were used to examine the psychometric properties of our draft instrument and explore its construct validity.    

Result: The final measure consisted of 10 items to assess the 4 central constructs of the Reasoned Action Approach for each of the 3 SDM behaviors. Attitudes were assessed with 2 items with reliability ranging from .85 - .87, depending on the behavior. Perceived Social Norms were assessed with 3 items with reliability ranging from .82-.89. Self-efficacy was assessed with 3 items with reliability ranging from .75-.86. Behavioral intentions were assessed with 2 items with reliability ranging from .80-.92.  Intention to engage in each of the 3 behaviors showed significant relationships with age (asking questions – p<.0001; discussing preferences – p<.0001; disagreeing with a recommendation – p<.05). Preferences for participation in decision-making were only significantly related to intentions to disagree with a recommendation (p<.0001), but not the other communication behaviors.  

Conclusion: The new theory-based measure of patient SDM communication behaviors is reliable and shows some initial evidence of construct validity. Further research is needed to examine its relationship with objective measures of SDM communication behavior.