Using Collabo<scp>RATE</scp>, a brief patient‐reported measure of shared decision making: Results from three clinical settings in the United States

Forcino, Rachel C; Barr, Paul; O’Malley, A. James; Arend, Roger; Castaldo, Molly G; Ozanne, Elissa M.; Percac‐Lima, Sanja; Stults, Cheryl D; Tai-Seale, Ming; Thompson, Rachel; Elwyn, Glyn

doi:10.1111/hex.12588

Cited by 79 publications

(74 citation statements)

References 19 publications

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“…The CollaboRate is translated into Norwegian, and is well validated. It has been shown to be useful in different patient populations and levels of care, and is equipped with a comprehensive description of interpretation . According to this, we appraised it to be a suitable instrument for our purpose.…”

Section: Methodsmentioning

confidence: 99%

“…This score is multiplied by 3.704 to give a recalculated response percentage score between 0 and 100. A ceiling effect is described for the instrument as a considerably share of the patients reported on the upper part of the scale in earlier studies . As our purpose was to investigate associations between practitioner attitudes and patient experiences, we considered the CollaboRate suitable for this study, in spite of these reports.…”

Section: Methodsmentioning

confidence: 99%

“…It has been shown to be useful in different patient populations and levels of care, and is equipped with a comprehensive description of interpretation. 4,38 According to this, we appraised it to be a suitable instrument for our purpose. The CollaboRate comprises three single questions dealing with tutoring and feedback to the patient about the health situation and attention payed by the practitioners to what matters most to the patient.…”

Section: The Collaboratementioning

confidence: 99%

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Practitioners' positive attitudes promote shared decision‐making in mental health care

Drivenes

Haaland

Mesel

et al. 2019

Evaluation Clinical Practice

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Rationale and aims There is a growing expectation of implementing shared decision making (SDM) in today's health care service, including mental health care. Traditional understanding of SDM may be too narrow to capture the complexity of treatments of mental health problems. Although the patients' contribution to SDM is well described, the contribution from the health care practitioners is less explored. Therefore, our aim was to explore the attitudes of practitioners in mental health care and the associations between practitioners' attitudes and SDM. Method We performed a cross‐sectional study where practitioners reported their sharing and caring attitudes on the Patient‐Practitioner Orientation Scale (PPOS) and age, gender, profession, and clinical working site. The patients reported SDM using the CollaboRate tool. We used a mixed effect model linking the data from each practitioner to one or more patients. We presented the findings and used them as background for a more philosophic reflection. Results We included 312 practitioners with mean age 46.1 years. Of the practitioners, 60 held a medical doctors degree, 97 were psychologists, and 127 held a college degree in nursing, social science, or pedagogy. Female practitioners reported higher sharing (4.79 vs 4.67 [range 1‐6], P = .04) and caring scores (4.77 vs 4.65 [range 1‐6], P = .02) than males. The regression model contained 206 practitioners and 772 patients. We found a higher probability for the patient to report high SDM score if the practitioner reported higher sharing scores, and lower probability if the practitioner worked in ambulatory care. Conclusions SDM in mental health care is complex and demands multifaceted preparations from practitioners as well as patients. The practitioners' attitudes are not sufficiently explored using one instrument. The positive association between practitioners' patient‐centred attitudes and SDM found in this study implies a relevance of the practitioners' attitudes for accomplishment of SDM processes in mental health care.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: The Collaboratementioning

confidence: 99%

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Practitioners' positive attitudes promote shared decision‐making in mental health care

Drivenes

Haaland

Mesel

et al. 2019

Evaluation Clinical Practice

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“…The basis of our experimental approach is to use CollaboRATE, a widely used SDM self‐reported instrument, as the starting questionnaire. This instrument was designed to rate clinicians or clinics efficiently . Results are reported as the percentage of patients visiting a clinician or a clinic who rated all three CollaboRATE questions using 9, the highest rating possible.…”

Section: Study 1 Rephrasing Items Into Reflection Questionsmentioning

confidence: 99%

“…This instrument was designed to rate clinicians or clinics efficiently. 13 Results are reported as the percentage of patients visiting a clinician or a clinic who rated all three CollaboRATE questions using 9, the highest rating possible.…”

Section: Questionnairesmentioning

confidence: 99%

Reflecting on shared decision making: A reflection‐quantification study

Kunneman

LaVecchia

Ospina

et al. 2019

Health Expectations

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Background Reflecting (“stop‐and‐think”) before rating may help patients consider the quality of shared decision making (SDM) and mitigate ceiling/halo effects that limit the performance of self‐reported SDM measures. Methods We asked a diverse patient sample from the United States to reflect on their care before completing the 3‐item CollaboRATE SDM measure. Study 1 focused on rephrasing CollaboRATE items to promote reflection before each item. Study 2 used 5 open‐ended questions (about what went well and what could be improved upon, signs that the clinician understood the patient's situation, how the situation will be addressed, and why this treatment plan makes sense) to invite reflection before using the whole scale. A linear analogue scale assessed the extent to which the plan of care made sense to the patient. Results In Study 1, 107 participants completed surveys (84% response rate), 43 (40%) rated a clinical decision of which 27 (63%) after responding to reflection questions. Adding reflection lowered CollaboRATE scores (“less” SDM) and reduced the proportion of patients giving maximum (ceiling) scores (not statistically significant). In Study 2, 103 of 212 responders (49%) fully completed the version containing reflection questions. Reflection did not significantly change the distribution of CollaboRATE scores or of top scores. Participants indicated high scores on the sense of their care plan (mean 9.7 out of 10, SD 0.79). This rating was weakly correlated with total CollaboRATE scores (rho = .4, P = .0001). Conclusion Reflection‐before‐quantification interventions may not improve the performance of patient‐reported measures of SDM with substantial ceiling/halo effects.

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Association of Patient Priorities–Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions

et al. 2019

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Health care may be burdensome and of uncertain benefit for older adults with multiple chronic conditions (MCCs). Aligning health care with an individual's health priorities may improve outcomes and reduce burden.OBJECTIVE To evaluate whether patient priorities care (PPC) is associated with a perception of more goal-directed and less burdensome care compared with usual care (UC).DESIGN, SETTING, AND PARTICIPANTS Nonrandomized clinical trial with propensity adjustment conducted at 1 PPC and 1 UC site of a Connecticut multisite primary care practice that provides care to almost 15% of the state's residents. Participants included 163 adults aged 65 years or older who had 3 or more chronic conditions cared for by 10 primary care practitioners (PCPs) trained in PPC and 203 similar patients who received UC from 7 PCPs not trained in PPC. Participant enrollment occurred between February 1, 2017, and March 31, 2018; follow-up extended for up to 9 months (ended September 30, 2018).INTERVENTIONS Patient priorities care, an approach to decision-making that includes patients' identifying their health priorities (ie, specific health outcome goals and health care preferences) and clinicians aligning their decision-making to achieve these health priorities. MAIN OUTCOMES AND MEASURES Primary outcomes included change in patients' OlderPatient Assessment of Chronic Illness Care (O-PACIC), CollaboRATE, and Treatment Burden Questionnaire (TBQ) scores; electronic health record documentation of decision-making based on patients' health priorities; medications and self-management tasks added or stopped; and diagnostic tests, referrals, and procedures ordered or avoided. RESULTSOf the 366 patients, 235 (64.2%) were female and 350 (95.6%) were white. Compared with the UC group, the PPC group was older (mean [SD] age, 74.7 [6.6] vs 77.6 [7.6] years) and had lower physical and mental health scores. At follow-up, PPC participants reported a 5-point greater decrease in TBQ score than those who received UC (ß [SE], -5.0 [2.04]; P = .01) using a weighted regression model with inverse probability of PCP assignment weights; no differences were seen in O-PACIC or CollaboRATE scores. Health priorities-based decisions were mentioned in clinical visit notes for 108 of 163 (66.3%) PPC vs 0 of 203 (0%) UC participants. Compared with UC patients, PPC patients were more likely to have medications stopped (weighted comparison, 52.0% vs 33.8%; adjusted odds ratio [AOR], 2.05; 95% CI, 1.43-2.95) and less likely to have self-management tasks (57.5% vs 62.1%; AOR, 0.59; 95% CI, 0.41-0.84) and diagnostic tests (80.8% vs 86.4%; AOR, 0.22; 95% CI, 0.12-0.40) ordered.CONCLUSIONS AND RELEVANCE This study's findings suggest that patient priorities care may be associated with reduced treatment burden and unwanted health care. Care aligned with patients' priorities may be feasible and effective for older adults with MCCs.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03600389

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Using CollaboRATE, a brief patient‐reported measure of shared decision making: Results from three clinical settings in the United States

Cited by 79 publications

References 19 publications

Practitioners' positive attitudes promote shared decision‐making in mental health care

Practitioners' positive attitudes promote shared decision‐making in mental health care

Reflecting on shared decision making: A reflection‐quantification study

Association of Patient Priorities–Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions

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