title: Trying to optimise the German version of the OPTION scale regarding the dyadic aspect of shared decision making.
abstract: OBJECTIVE
  The OPTION scale ("observing patient involvement in decision making") assesses the extent to which clinicians involve patients in decisions across a range of situations in clinical practice. It so far just covers physician behavior. We intended to modify the scoring of the OPTION scale to incorporate active patient behavior in consultations.
  
  
  METHODS
  Modification was done on scoring level, attempting a dyadic, relationship-centred approach in that high ratings can be evoked also by the behaviour of active patients. The German version of the OPTION scale was compared with a modified version by analysing video recordings of primary care consultations dealing with cardiovascular prevention. Fifteen general practitioners provided 40 videotaped consultations. Videos were analysed by two rater pairs and two experts in shared decision making (SDM).
  
  
  RESULTS
  Reliability measures of the modified version were lower than those of the original scale. Significant associations of the dichotomised scale with the expert SDM rating as well as with physicians' expertise in SDM were only found for the modified OPTION scale. Receiver Operating Characteristic (ROC) analyses confirmed a valid differentiation between the presence of SDM (yes/no) on total score level, even though the cut-off point was quite low. Standard deviations of the single items in the modified version were higher compared to the original OPTION scale, while the means of total scores were similar.
  
  
  CONCLUSIONS
  The original OPTION scale is physician-centered and neglects the activity and a possible self-involvement of the patient. Our modified instruction was able to capture the dyadic element partially. The development of a separate dyadic instrument might be more promising.
authors.affiliation: Dr. Oliver Hirsch, PhD, Department of General Practice/Family Medicine, Philipps-University Marburg, Karl-von-Frisch-Strasse 4, 35032 Marburg, Germany, E-mail: oliver.hirsch@staff.uni-marburg.de.
authors.forename: H
authors.initials: H
authors.lastname: Keller
authors.forename: O
authors.initials: O
authors.lastname: Hirsch
authors.forename: M
authors.initials: M
authors.lastname: Müller-Engelmann
authors.forename: M
authors.initials: M
authors.lastname: Heinzel-Gutenbrunner
authors.forename: T
authors.initials: T
authors.lastname: Krones
authors.forename: N
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D003142:Communication; D003431:Cross-Cultural Comparison; D018592:Cross-Over Studies; D003657:Decision Making; D004650:Employee Performance Appraisal / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011594:Psychometrics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014741:Video Recording
keywords: Decision making; cross-over studies; patient participation; physician-patient relations; weights and measures