Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey

doi:10.1016/j.pec.2012.02.010

Patient Education and Counseling

Volume 88, Issue 1, July 2012, Pages 100-105

https://doi.org/10.1016/j.pec.2012.02.010 Get rights and content

Abstract

Objective

The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations.

Methods

A randomly selected age-proportionate national sample of adults (aged 21–70 years) stratified on race, ethnicity, and gender (N = 488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the Shared Decision Making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD.

Results

After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R² = .368, p < .001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD.

Conclusion

SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly.

Practice implications

By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes.

Introduction

A majority of adults routinely engage in health-related decision-making that has significant impact for personal health and well-being and broader public health outcomes. Recent national surveys in North America document the high prevalence of patient decision-making and associated unmet needs for decision-making support among patients who seek health care services [1], [2]. Shared decision-making (SDM) is receiving increasing attention as a solution to better meet patient decision support needs by improving the quality of patient–provider health care decision-making processes. SDM can be broadly defined as an interactive, collaborative process between patients and health care providers that is used to make health care decisions, that is characterized by several features of the patient–provider interaction: (a) eliciting and acknowledging patients’ preferences for participation; (b) giving choices as to how the decision-making process will proceed; and (c) mutually respecting and adhering to choices [3]. SDM is advocated on premises that patients have a right of self-determination, as well as an expectation that patient involvement in shared decision-making can increase the likelihood of treatment adherence [4], in which adherence is conceptualized as the extent to which a patient continues to implement a previously made treatment decision. Research on the relationship between SDM and adherence is important because patients themselves usually control the extent to which they adhere to health treatments, and adherence has significant impact on health and other outcomes.

Recently, Stalmeier proposed a conceptual model to illustrate effects of decision aids on adherence behavior [4]. The model posits researchable hypotheses (described as ‘hypothetical’ pathways in the model) for how processes of communication and deliberation in SDM can support treatment adherence. Specifically, decision aids are hypothesized to strengthen attitudes toward choices (options), which in turn can strengthen the relationship between attitudes and adherence behavior. Patient attitudes about options can be measured in multiple ways, including but not limited to strength and persistence of treatment preferences, and level of satisfaction with decisions. While there is as yet inconclusive empirical support for the hypothesized linkages of SDM, attitudes, and adherence, prior findings hold sufficient promise such that future studies are proposed to more definitely examine these relationships [4], [5]. From a public health perspective, information about the association of shared decision-making and attitudes toward options is important because these are potentially modifiable variables that can inform improved interventions to support treatment adherence, and improved adherence can lead to improved health outcomes.

The purpose of this study was to examine the relationship of patient perceptions of shared decision-making (SDM) and an attitude measure, satisfaction with decision (SWD) [6], [7], within a larger survey that was conducted to validate a newly developed measure of SDM, the Shared Decision Making-9 questionnaire (SDM-Q-9), in a U.S. national sample [8], [9]. The secondary analysis reported in this paper extends findings of prior national surveys [1], [2] by examining the association of SDM and SWD for a recently made decision related to diagnosis, treatment, or referral for a personally experienced health issue. The specific analysis reported in this paper and recency of recall of decision-making (decision made in the past 3 months) have not been addressed in prior national surveys which have used longer recall time periods; i.e., ever having made a complex health-related decision [2], or having made a medical decision within the past two years [1]. Within the framework of the Stalmeier model [4], the overall hypothesis examined in the present study was that SDM would exhibit a positive relationship with SWD. Additional analyses were conducted to further explore: (a) the contribution of specific aspects of SDM to SWD and (b) the association of socio-demographic and other decision-making variables with SWD. To provide context about the decision-making circumstances of the respondents and to place our study results in context of other surveys of health-related decision-making [1], [2], we also summarized the types of reported health-related decisions (relating to diagnosis, treatment or referral for health concerns) and the specific categories of health concerns that were a focus of decision-making. We also were able to compare the socio-demographic characteristics of our obtained sample to the ResearchMatch population.

Section snippets

Recruitment and sampling

The present study was based on a secondary analysis of data from a larger survey study that was conducted to validate the Shared Decision Making Questionnaire-9 (SDM-Q-9) [8] in a U.S. national sample. Recruitment for the study was done via ResearchMatch, a national health volunteer registry that was created by several academic institutions and supported by the U.S. National Institutes of Health as part of the Clinical Translational Science Award (CTSA) program. ResearchMatch has a large

Sample characteristics

Table 1 displays the overall sample characteristics for socio-demographic variables. Fig. 1 presents the study flow diagram. The obtained sample had similarities and some differences compared to the overall ResearchMatch population. The sample was somewhat higher on proportion of white respondents, lower on African-American respondents, and higher on Hispanic respondents compared to ResearchMatch (82%, 10%, 5%, respectively). The obtained sample had similar percentages to ResearchMatch for

Discussion

As hypothesized, SDM-Q-9 score was positively associated with SWD. By identifying factors such as SDM that may increase satisfaction with decisions, this can support improved intervention approaches to encourage patients to be involved in their own care, including collaboration on health management plans that they will be more likely to follow if they are satisfied with their decisions. Although there are many factors that contribute to whether or not patients are satisfied with their care, one

Acknowledgements

The authors thank Drs. Amy Ferketich and Randi Foraker of The Ohio State University College of Public Health for their reviews of earlier drafts of this manuscript. The results reported in this manuscript were used in the lead author's Master of Public Health (MPH) Culminating Project, completed in partial fulfillment of requirements for the MPH degree. Portions of the results were presented at the June 2011 International Shared Decision Making Conference in Maastricht, The Netherlands. The

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Medical Decision MakingShared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Recruitment and sampling

Sample characteristics

Discussion

Acknowledgements

Soc Sci Med

Patient Educ Couns

The DECISIONS study: a nationwide survey of United States adults regarding 9 common medical decisions

Med Decis Making

A survey of the decision-making needs of Canadians faced with complex health decisions

Health Expect

Adherence and decision aids: a model and a narrative review

Med Decis Making

Medical Decision Making
Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey