title: Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations.
abstract: BACKGROUND
  Shared Decision Making (SDM) is widely accepted as the preferred method for reaching treatment decisions in the oncology setting including those about clinical trial participation: however, there is some disagreement between researchers over the components of SDM. Specific standardized coding systems are needed to help overcome this difficulty.
  
  
  OBJECTIVE
  The first objective was to describe the development of an oncology specific SDM coding system, the DAS-O. The second objective was to provide reliability and validity data supporting the DAS-O.
  
  
  METHODS
  Consultation data were available from tertiary cancer center out patient oncology clinics in: Australia, New Zealand (ANZ), Switzerland, Germany and Austria (SGA). Patients were women with a confirmed diagnosis of early stage breast cancer. Reliability data were from 18 randomly selected coded transcripts drawn from ANZ and SGA. Concurrent validity data are from 55 (ANZ) consultations.
  
  
  METHODS
  Inter and Intra rater reliability data was evaluated using Kappa correlation statistics and correlation coefficients. Correlation coefficients were used to assess concurrent validity between the DAS-O and two other SDM coding systems, OPTION and DSAT.
  
  
  RESULTS
  Inter and Intra rater reliability for the system were high with average Kappas of 0.58 and 0.65 respectively. Correlation coefficients between DAS-O and OPTION was 0.73 and >0.5 for DSAT.
  
  
  CONCLUSIONS
  We have developed a reliable and valid coding system for identifying and rating the quality of SDM in breast cancer consultations.
authors.affiliation: Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Brown
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Ilona
authors.initials: I
authors.lastname: Juraskova
authors.forename: Karin
authors.initials: K
authors.lastname: Ribi
authors.forename: Daniela
authors.initials: D
authors.lastname: Gerber
authors.forename: Jurg
authors.initials: J
authors.lastname: Bernhard
authors.forename: Martin H N
authors.initials: MH
authors.lastname: Tattersall
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D015588:Observer Variation; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations; D015203:Reproducibility of Results