The Psychometric Properties of CollaboRATE: A Fast and Frugal Patient-Reported Measure of the Shared Decision-Making Process

Abstract

BackgroundPatient-centered health care is a central component of current health policy agendas. Shared decision making (SDM) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace. However, the measurement of SDM continues to prove challenging. Reviews have highlighted the need for a patient-reported measure of SDM that is practical, valid, and reliable to assist implementation efforts. In consultation with patients, we developed CollaboRATE, a 3-item measure of the SDM process.ObjectiveThere is a need for scalable patient-reported measure of the SDM process. In the current project, we assessed the psychometric properties of CollaboRATE.MethodsA representative sample of the US population were recruited online and were randomly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013. Three dimensions of SDM were manipulated in the encounters: (1) explanation of the health issue, (2) elicitation of patient preferences, and (3) integration of patient preferences. Participants then completed CollaboRATE (possible scores 0-100) in addition to 2 other patient-reported measures of SDM: the 9-item Shared Decision Decision Making Questionnaire (SDM-Q-9) and the Doctor Facilitation subscale of the Patient’s Perceived Involvement in Care Scale (PICS). A subsample of participants was resurveyed between 7 and 14 days after the initial survey. We assessed CollaboRATE’s discriminative, concurrent, and divergent validity, intrarater reliability, and sensitivity to change.ResultsThe final sample consisted of 1341 participants. CollaboRATE demonstrated discriminative validity, with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero (mean score: 46.0, 95% CI 42.4-49.6) to 3 (mean score 85.8, 95% CI 83.2-88.4). CollaboRATE also demonstrated concurrent validity with other measures of SDM, excellent intrarater reliability, and sensitivity to change; however, divergent validity was not demonstrated.ConclusionsThe fast and frugal nature of CollaboRATE lends itself to routine clinical use. Further assessment of CollaboRATE in real-world settings is required.

Randomized Trial of a Social Networking Intervention for Cancer-Related Distress

“…Although these rates of engagement compare favorably with a number of other e-health interventions (62), there are notable examples of online interventions in cancer survivors that yield higher levels of involvement (63). For example, in an online health behavior change intervention, Surviving and Thriving with Cancer , Bantum et al (64) demonstrated very high levels of user participation, at least with respect to posting content. Because of differences in intervention content and procedures, in addition to differences in how engagement is measured across interventions, it is very difficult to evaluate which intervention elements are most critical for improving effect sizes.…”

Evaluating CollaboRATE in a clinical setting: analysis of mode effects on scores, response rates and costs of data collection

“…9 24 This scoring technique is a strategy for aiding interpretation while avoiding potential ceiling effects common among clinician performance assessments completed by patients. 9 Incomplete CollaboRATE surveys were not included in analysis.…”

“…CollaboRATE has demonstrated psychometric soundness, 9 and has also been used in a demonstration project to assess differences in SDM across 34 clinical teams in England. 10 In addition, Blue Shield of California is using CollaboRATE to assess SDM as part of a preauthorisation process for joint replacement.…”

Shared Decision Making for Treatment of Cancer: Challenges and Opportunities

“…Elwyn suggests questions along three constructs related to patient understanding: information provision, preference elicitation, and preference integration of their perspective into final treatment decisions 10 : The construct is measured via patient report of the amount of clinician effort to help a patient (1) understand the health issues, (2) listen to the things that matter most, and (3) include what matters most when choosing what to do next. 11,12 The measure has the potential advantage of low patient burden and high practical use in a variety of medical settings.…”