Reflecting on shared decision making: A reflection-quantification study

Marleen Kunneman, Christina M. LaVecchia, Naykky Singh Ospina, Abd Moain Abu Dabrh, Emma M. Behnken, Patrick Wilson, Megan E. Branda, Ian G. Hargraves, Kathleen J. Yost, Richard Frankel, Victor M. Montori

Research output: Contribution to journalArticle

Abstract

Background: Reflecting (“stop-and-think”) before rating may help patients consider the quality of shared decision making (SDM) and mitigate ceiling/halo effects that limit the performance of self-reported SDM measures. Methods: We asked a diverse patient sample from the United States to reflect on their care before completing the 3-item CollaboRATE SDM measure. Study 1 focused on rephrasing CollaboRATE items to promote reflection before each item. Study 2 used 5 open-ended questions (about what went well and what could be improved upon, signs that the clinician understood the patient's situation, how the situation will be addressed, and why this treatment plan makes sense) to invite reflection before using the whole scale. A linear analogue scale assessed the extent to which the plan of care made sense to the patient. Results: In Study 1, 107 participants completed surveys (84% response rate), 43 (40%) rated a clinical decision of which 27 (63%) after responding to reflection questions. Adding reflection lowered CollaboRATE scores (“less” SDM) and reduced the proportion of patients giving maximum (ceiling) scores (not statistically significant). In Study 2, 103 of 212 responders (49%) fully completed the version containing reflection questions. Reflection did not significantly change the distribution of CollaboRATE scores or of top scores. Participants indicated high scores on the sense of their care plan (mean 9.7 out of 10, SD 0.79). This rating was weakly correlated with total CollaboRATE scores (rho =.4, P =.0001). Conclusion: Reflection-before-quantification interventions may not improve the performance of patient-reported measures of SDM with substantial ceiling/halo effects.

Original languageEnglish (US)
JournalHealth Expectations
DOIs
StateAccepted/In press - Jan 1 2019

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Decision Making
Epidemiologic Effect Modifiers
Therapeutics

Keywords

  • argumentation
  • communication
  • measurement
  • patient involvement
  • shared decision making

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Kunneman, M., LaVecchia, C. M., Singh Ospina, N., Abu Dabrh, A. M., Behnken, E. M., Wilson, P., ... Montori, V. M. (Accepted/In press). Reflecting on shared decision making: A reflection-quantification study. Health Expectations. https://doi.org/10.1111/hex.12953

Reflecting on shared decision making : A reflection-quantification study. / Kunneman, Marleen; LaVecchia, Christina M.; Singh Ospina, Naykky; Abu Dabrh, Abd Moain; Behnken, Emma M.; Wilson, Patrick; Branda, Megan E.; Hargraves, Ian G.; Yost, Kathleen J.; Frankel, Richard; Montori, Victor M.

In: Health Expectations, 01.01.2019.

Research output: Contribution to journalArticle

Kunneman, M, LaVecchia, CM, Singh Ospina, N, Abu Dabrh, AM, Behnken, EM, Wilson, P, Branda, ME, Hargraves, IG, Yost, KJ, Frankel, R & Montori, VM 2019, 'Reflecting on shared decision making: A reflection-quantification study', Health Expectations. https://doi.org/10.1111/hex.12953
Kunneman M, LaVecchia CM, Singh Ospina N, Abu Dabrh AM, Behnken EM, Wilson P et al. Reflecting on shared decision making: A reflection-quantification study. Health Expectations. 2019 Jan 1. https://doi.org/10.1111/hex.12953
Kunneman, Marleen ; LaVecchia, Christina M. ; Singh Ospina, Naykky ; Abu Dabrh, Abd Moain ; Behnken, Emma M. ; Wilson, Patrick ; Branda, Megan E. ; Hargraves, Ian G. ; Yost, Kathleen J. ; Frankel, Richard ; Montori, Victor M. / Reflecting on shared decision making : A reflection-quantification study. In: Health Expectations. 2019.
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