title: Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared decision making.
abstract: OBJECTIVE
  Patient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered.
  
  
  METHODS
  The study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale).
  
  
  RESULTS
  OPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations.
  
  
  CONCLUSIONS
  Existing SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement.
  
  
  CONCLUSIONS
  Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN25267500.
authors: Institute of Neuroimmunology and Clinical MS Research, University Medical Center Hamburg, Hamburg, Germany.
authors: Jürgen
authors: J
authors: Kasper
authors: Christoph
authors: C
authors: Heesen
authors: Sascha
authors: S
authors: Köpke
authors: Gary
authors: G
authors: Fulcher
authors: Friedemann
authors: F
authors: Geiger
mesh_terms: D015331:Cohort Studies; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D007167:Immunotherapy; D009103:Multiple Sclerosis / Q000628:therapy; D010358:Patient Participation; D010465:Perception; D010817:Physician-Patient Relations