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de Filippis R, Aloi M, Pilieci AM, Boniello F, Quirino D, Steardo L, Segura-Garcia C, De Fazio P. Psychometric Properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9): Validation of the Italian Version in a Large Psychiatric Clinical Sample. CLINICAL NEUROPSYCHIATRY 2022; 19:264-271. [PMID: 36101644 PMCID: PMC9442857 DOI: 10.36131/cnfioritieditore20220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) is one of the most frequently used tools for assessing patients' involvement in medical decision-making, but so far, it not been validated in Italian. We aimed to validate the Italian version of the SDM-Q-9 in a clinical sample of patients suffering from major psychiatric disorders. METHOD We involved 307 consecutive patients affected by major psychiatric disorders (including schizophrenia spectrum disorders, affective disorders and eating disorders) in a real-world outpatient clinical setting. Confirmatory Factor Analysis (CFA) was conducted to examine the latent structure of the SDM-Q-9. Cronbach's alpha and correlations between the SDM-Q-9 and the Observing Patient Involvement (OPTION) scale were calculated to measure internal consistency and convergent validity respectively. RESULTS The final sample was made up of 289 participants (response rate 94.1%) who completed the assessment. CFA confirmed the unidimensional structure as in the original version (χ2/df= 1.69; CFI= 0.98; TLI= 0.97; RMSEA= 0.05; SRMR= 0.08). Internal consistency of the total scale was Cronbach's α = .86. Regarding construct validity, we found several correlations between the SDM-Q-9 and OPTION scale. CONCLUSIONS Our findings suggest that the Italian version of SDM-Q-9 performs well if compared to other languages validated versions, so it is a useful patient-centred measure to assess the involvement in medical decision-making (SDM) of patients from clinical samples from the Italian-speaking population.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Matteo Aloi
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Anna Maria Pilieci
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Boniello
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Daria Quirino
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy,Corresponding author Pasquale De Fazio
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Klemmt M, Henking T, Neuderth S. [The Autonomy of Patients in Inpatient Medical Rehabilitation - Aspects of Endangerment and Preservation]. REHABILITATION 2021; 61:125-133. [PMID: 34768295 DOI: 10.1055/a-1647-1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study is to identify aspects within inpatient medical rehabilitation that may endanger or preserve the autonomy of patients. METHODS A scoping review was carried out on the basis of the current state of scientific knowledge. The methodological approach was based on the specifications of the Joanna Briggs Institute. The research and generation of findings were logged according to the PRISMA-ScR checklist. RESULTS The final study inclusion comprises 39 empirical and normative-theoretical contributions. Autonomy-threatening aspects were assigned to the following domains: Rehabilitation system, rehabilitation clinics, staff, patients and third parties. Aspects potentially preserving the autonomy of patients included the following domains: Rehabilitation clinics, staff, concepts and forms of expression as well as instruments. CONCLUSION A large number of heterogeneous aspects can endanger, but can also preserve or promote the autonomy of patients during their stay in inpatient medical rehabilitation. These are located throughout in the entire rehabilitation process and concern the structural, organizational and personal level. The autonomy of patients should not only be treated as an outcome of rehabilitation, but also as a requirement for structures and actors during the rehabilitation stay.
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Affiliation(s)
- Malte Klemmt
- Institut für Angewandte Sozialwissenschaften, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Deutschland
| | - Tanja Henking
- Institut für Angewandte Sozialwissenschaften, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Deutschland
| | - Silke Neuderth
- Institut für Angewandte Sozialwissenschaften, Hochschule für angewandte Wissenschaften Würzburg-Schweinfurt, Deutschland
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Schellartz I, Ohnhaeuser T, Mettang T, Scholten N. Information about different treatment options and shared decision making in dialysis care - a retrospective survey among hemodialysis patients. BMC Health Serv Res 2021; 21:673. [PMID: 34238295 PMCID: PMC8268609 DOI: 10.1186/s12913-021-06599-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hemodialysis (HD) and peritoneal dialysis (PD) are equivalent treatment alternatives for patients with end stage renal disease. In Germany, there is a legal obligation to inform every patient about all treatment alternatives and their possible harms and benefits. However, there is a low utilization of PD. Therefore, the question arises, whether HD patients perceive that they were informed about different dialysis options. We further investigate, if personal characteristics of informed and non-informed patients vary, and if both groups experienced the decision for their dialysis treatment as shared decision making (SDM). Methods The database was a nationwide postal survey of 590 HD patients from two statutory health insurers in Germany. Participants were asked whether they have been informed about both dialysis options. A logistic regression model examines impact factors on this information. We investigate differences in the German version of the 9-item SDM Questionnaire (SDM-Q-9) between informed and non-informed patients with a multivariate linear regression model. Results 56 % of the respondents reported they had been informed about different dialysis treatment options. Patients older than 65 had a 61 % lower chance than patients ≤ 65 for this information (p < 0.001). High educated patients had a 47 % higher chance for this information than patients with low education level (p = 0.030). Informed patients rated a higher SDM-Q-9 scores than non-informed patients (76.9 vs. 44.2; p < 0.001). Non-informed patients showed high values in those SDM-Q-9 items which had no regard to different treatment options. Conclusions A great proportion of HD patients – mostly elderly patients and patients with a low education level – did not perceive that they were informed about different dialysis options before dialysis was initiated. The current obligation to provide information about all treatment alternatives in Germany is a first step to assure the unselected access to different treatment options. But it has not reached routine application in health care yet. Information about different treatment options can pave the way for SDM. While SDM is considered to be a valuable tool in clinical medicine, there is still room for improvement for its successful implementation when it comes to decision making on different dialysis treatment options. Trial registration The MAU-PD study (Multidimensional analysis of causes for the low prevalence of ambulatory peritoneal dialysis in Germany) is registered at the German Clinical Trials Register.
DRKS-ID: DRKS00012555 Link: https://www.drks.de/drks_web/setLocale_EN.do. Date of Registration in DRKS: 2018/01/04.
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Affiliation(s)
- Isabell Schellartz
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany.
| | - Tim Ohnhaeuser
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany
| | | | - Nadine Scholten
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany
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Mitgutsch V, Stummer H. Should we enhance patient participation in cardiac rehabilitation? An analysis of the perspective of health professionals on setting rehabilitation goals. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Partizipation von Patienten im Kontext der stationären Kinder- und Jugendpsychiatrie – ein Scoping Review. Prax Kinderpsychol Kinderpsychiatr 2020; 69:700-719. [DOI: 10.13109/prkk.2020.69.8.700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Müller E, Diesing A, Rosahl A, Scholl I, Härter M, Buchholz A. Evaluation of a shared decision-making communication skills training for physicians treating patients with asthma: a mixed methods study using simulated patients. BMC Health Serv Res 2019; 19:612. [PMID: 31470856 PMCID: PMC6716840 DOI: 10.1186/s12913-019-4445-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION5, the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION5: t (26) = − 5.16; p < 0.001) (SDM-Q-Doc: t (26) = − 4.39; p < 0.001) (SDM-Q-9: t (26) = − 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. Conclusion The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany.
| | - Alice Diesing
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
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Wagner A, Radionova N, Rieger MA, Siegel A. Patient Education and Continuing Medical Education to Promote Shared Decision-Making. A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142482. [PMID: 31336828 PMCID: PMC6678248 DOI: 10.3390/ijerph16142482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
Background: Over recent years, the use of decision aids to promote shared decision-making have been examined. Studies on patient education and on continuing medical education for physicians are less common. This review analyzes intervention and evaluation studies on patient education and continuing medical education which aim to enhance shared decision-making. The following study parameters are of interest: Study designs, objectives, numbers of participants in the education courses, interventions, primary results, and quality of the studies. Methods: We systematically searched for suitable studies in two databases (Pubmed and the Cochrane Database of Systematic Reviews) from the beginning of April through to mid-June 2016. Results: 16 studies from a total of 462 hits were included: Three studies on patient education and 13 studies on continuing medical education for physicians. Overall, the study parameters were heterogeneous. Major differences were found between the courses; how the courses were conducted, their length, and participants. Conclusions: The differences found in the studies made it difficult to compare the interventions and the results. There is a need for studies that systematically evaluate and further develop interventions in this area to promote shared decision-making.
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Affiliation(s)
- Anke Wagner
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Natalia Radionova
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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Drewelow E, Santos S, Hornung A, Altiner A, Löffler C, Pentzek M, Wilm S, Löscher S, Wollny A. [Does place of residence have an influence on shared decision making for patients with type 2 diabetes in general practice?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2018; 137-138:36-41. [PMID: 30177481 DOI: 10.1016/j.zefq.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In the last 20 years, patient involvement in clinical decision-making has continuously gained traction in scientific and clinical (including general practice, GP) discussions. Patients with chronic conditions in particular may benefit from active involvement. Referring to existing studies on shared decision making and regional differences; patients with poorly controlled diabetes mellitus type 2 (DM2) were used as an example to investigate the perceived involvement during clinical decision making in general practice. Differences in treatment options based on the patients' place of residence (East- and West Germany) were compared. METHODS 501 West- (North-Rhine-Westphalia, NRW) and 338 East-German (Mecklenburg-Western Pomerania, MWP) patients with DM2 and HbA1c levels≥8.0 were assessed during the cluster-randomised controlled trial DEBATE, which was conducted between 2011 and 2012. The questionnaire to measure participatory decision making (Q-PDM) was used in order to provide an estimate of their involvement in clinical decision making processes, and baseline data was analysed before intervention. The standardised Q-PDM summed value was compared among the different subgroups (i. e., place of residence, age, sex) using bivariate group analyses (t tests), and a multivariate regression analysis was conducted. RESULTS Patients living in the MWP region perceived a higher level of involvement in GP decision making than NRW residents. Younger patients with DM2 showed higher Q-PDM summed values than older patients. When all variables, including 'GP practice' (number of patients per GP/cluster), were considered together in the multivariate regression analysis, the place of residence would no longer show an independent effect on perceived decision making. The expected difference between MWP and NRW (i. e. East/West Germany) could not be confirmed, while a significant difference remained with regard to age. Education, population density, sex and marital status did not show any relevant differences. CONCLUSION Patient age remains an important factor influencing the perceived involvement in joint decision making and should be taken into account while implementing clinical decision making processes in the future. It is possible that patients of different age and with different chronic diseases may need different decision support offerings (e. g., educational videos, booklets or computer-based decision aids). Trainings in communication skills or in the implementation of patient-centred communication might be effective on the GP level to reduce possible barriers to shared decision making.
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Affiliation(s)
- Eva Drewelow
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Deutschland.
| | - Sara Santos
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anne Hornung
- Institut für Biostatistik und Informatik in Medizin und Alternsforschung, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Attila Altiner
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Christin Löffler
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Michael Pentzek
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Stefan Wilm
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Susanne Löscher
- Institut für Allgemeinmedizin (ifam), Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anja Wollny
- Institut für Allgemeinmedizin, Universitätsmedizin Rostock, Rostock, Deutschland
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Breuning M, Lucius-Hoene G, Burbaum C, Himmel W, Bengel J. [Patient experiences and patient centeredness : The website project DIPEx Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:453-461. [PMID: 28251275 DOI: 10.1007/s00103-017-2524-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient centeredness is a central concept in the treatment and rehabilitation of persons with chronic illness in Germany. There are various concepts of and approaches to patient centeredness, most of them developed from the perspective of health care research and the institutions. In terms of participation requirements, there has been a lack of understanding of the patient's perspective and experiences so far. In this article, the authors assume that the collection and analysis of patient experiences can improve patient participation and provide access to the experience of living and coping with an illness, including the patient's interactions with the health care system, their participation, and their preferences for participation. Potential uses for and the limits and risks of utilizing patient experiences are discussed, using the example of the website project Krankheitserfahrungen.de (DIPEx Germany). The project collects patient experiences in the form of narrative interviews. In the course of sharing their stories, the speakers become experts on their own lives and describe where and how they feel engaged in their health care and how they wish to become further engaged, thereby experiencing participation in terms of the International Classification of Functioning. The experience of rehabilitation is viewed in a comprehensive manner for those affected. It is not limited to experiences in specific institutions, but rather, the patient experience includes the context and processes, and describes how patients can find their way back to their lives after the interruption of an illness.
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Affiliation(s)
- Martina Breuning
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland.
| | - Gabriele Lucius-Hoene
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Christina Burbaum
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Jürgen Bengel
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
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Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies-A systematic review. PLoS One 2017; 12:e0173904. [PMID: 28358864 PMCID: PMC5373562 DOI: 10.1371/journal.pone.0173904] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) is a 9-item measure of the decisional process in medical encounters from both patients' and physicians' perspectives. It has good acceptance, feasibility, and reliability. This systematic review aimed to 1) evaluate the use of the SDM-Q-9 and SDM-Q-Doc in intervention studies on shared decision making (SDM) in clinical settings, 2) describe how the SDM-Q-9 and SDM-Q-Doc performed regarding sensitivity to change, and 3) assess the methodological quality of studies and study protocols that use the measure. METHODS We conducted a systematic review of studies published between 2010 and October 2015 that evaluated interventions to facilitate SDM. The search strategy comprised three databases (EMBASE, PsycINFO, and Medline), reference tracking, citation tracking, and personal knowledge. Two independent reviewers screened titles and abstracts as well as full texts of potentially relevant records. We extracted the data using a pilot tested sheet, and we assessed the methodological quality of included studies using the Quality Assessment Tools from the U.S. National Institute of Health (NIH). RESULTS Five completed studies and six study protocols fulfilled the inclusion criteria. The measure was used in a variety of health care settings, mainly in Europe, to evaluate several types of interventions. The reported mean sum scores ranged from 42 to 75 on a scale from 0 to 100. In four studies no significant change was detected in the mean-differences between main groups. In the fifth study the difference was small. Quality assessment revealed a high risk of bias in four of the five completed studies, while the study protocols received moderate quality ratings. CONCLUSIONS We found a wide range of areas in which the SDM-Q-9 and SDM-Q-Doc were applied. In the future this review may help researchers decide whether the measure fits their purposes. Furthermore, the review revealed risk of bias in previous trials that used the measure, and may help future trials decrease this risk. More research on the measure's sensitivity to change is strongly suggested.
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Dirmaier J, Härter M. Stärkung der Selbstbeteiligung in der Rehabilitation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:411-9. [DOI: 10.1007/s00103-011-1243-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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