Are you SURE?: Assessing patient decisional conflict with a 4-item screening test.
OBJECTIVE
To assess the reliability and validity of the 4-item SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test for decisional conflict in patients.


METHODS
Cross-sectional study.


METHODS
Four family medicine groups in Quebec and 1 rural academic medical centre in New Hampshire.


METHODS
One hundred twenty-three French-speaking pregnant women considering prenatal screening for Down syndrome and 1474 English-speaking patients referred to watch condition-specific video decision aids.


METHODS
Cronbach alpha was used to assess the reliability of SURE. A factorial analysis was performed to assess its unidimensionality. The Pearson correlation coefficient was computed between SURE and the Decisional Conflict Scale to assess concurrent validation. A t test procedure comparing the SURE scores of patients who had made decisions with the scores of those who had not was used to assess construct validation.


RESULTS
Among the 123 French-speaking pregnant women, 105 (85%) scored 4 out of 4 (no decisional conflict); 10 (8%) scored 3 (<or= 3 indicates decisional conflict); 7 (6%) scored 2; and 1 (1%) scored 1. Among the 1474 English-speaking treatment-option patients, 981 (67%) scored 4 out of 4; 272 (18%) scored 3; 147 (10%) scored 2; 54 (4%) scored 1; and 20 (1%) scored 0. The reliability of SURE was moderate (Cronbach alpha of 0.54 in French-speaking pregnant women and 0.65 in treatment-option patients). In the group of pregnant women, 2 factors accounted for 72% of the variance. In the treatment-option group, 1 factor accounted for 49% of the variance. In the group of pregnant women, SURE correlated negatively with the Decisional Conflict Scale (r = -0.46; P < .0001); and in the group of treatment-option patients, it discriminated between those who had made a choice for a treatment and those who had not (P < .0001).


CONCLUSIONS
The SURE screening test shows promise for screening for decisional conflict in both French- and English-speaking patients; however, future studies should assess its performance in a broader group of patients.
Légaré
France
F
Department of Family Medicine at Laval University in Quebec city, Que. france.legare@mfa.ulaval.ca
Kearing
Stephen
S
Clay
Kate
K
Gagnon
Susie
S
D'Amours
Denis
D
Rousseau
Michel
M
O'Connor
Annette
A
D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D004314:Down Syndrome / Q000175:diagnosis; D005260:Female; D006801:Humans; D009513:New Hampshire; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000523:psychology*; D011792:Quebec; D015203:Reproducibility of Results