Schwerpunkt| Volume 106, ISSUE 4, P264-271, 2012

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The OPTION scale for the assessment of shared decision making (SDM): methodological issues

  • Jennifer Nicolai
    Korrespondenzadresse. Dr. Jennifer Nicolai, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Phone +49-6221-56-37410; Fax: +49-6221-56-8450.
    Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, GermanyAbteilung für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Ruprecht Karls Universität Heidelberg
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  • Morten Moshagen
    Psychologie III, Universität Mannheim, Germany
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  • Wolfgang Eich
    Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, GermanyAbteilung für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Ruprecht Karls Universität Heidelberg
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  • Christiane Bieber
    Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, GermanyAbteilung für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Ruprecht Karls Universität Heidelberg
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      Promoting patient involvement in medical decision making has become a desirable goal in medical consultations. Reliable and valid measures are necessary to evaluate interventions designed to promote shared decision making and to understand determinants and associations. The OPTION (“observing patient involvement”) scale is the most prominent observation instrument for assessing the extent to which clinicians actively involve patients in decision making.


      This paper discusses psychometric and methodological characteristics of the OPTION scale.


      There is little support for the purported unidimensional structure. Although reliabilities are acceptable, results are highly heterogeneous across studies. There is also little evidence concerning validity. In particular, studies mainly failed to support convergent validity. Additional issues pertain to lack of item independence, restriction of range, and failure to consider dyadic aspects.


      Given these findings, a number of methodological and conceptual issues still need to be addressed for the effective measurement of patient involvement. Directions for future research are discussed.



      Die Beteiligung von Patienten an medizinischen Entscheidungen ist zu einem wichtigen Qualitätsmerkmal in Konsultationen geworden. Die Evaluation von Interventionen zur Förderung partizipativer Entscheidungsfindung und Forschung zum Verständnis von Determinanten effektiver medizinischer Entscheidungsfindung verlangt reliable und valide Messinstrumente. OPTION ist das am weitesten verbreitete Beobachtungsinstrument zur Erfassung des Ausmaßes, in dem Ärzte ihre Patienten aktiv an der Entscheidungsfindung beteiligen.


      In dieser Arbeit werden psychometrische und methodologische Aspekte der OPTION-Skala diskutiert.


      Für die angenommene einfaktorielle Struktur gibt es keine klare Evidenz. Die Reliabilitäten liegen meist im akzeptablen Bereich, sind über verschiedene Studien heterogen. Die Validität ist kaum belegt. Insbesondere die konvergente Validität von OPTION konnte nicht bestätigt werden. Als weitere Probleme werden Abhängigkeiten zwischen Items, geringe Streuung in den OPTION-Werten und die fehlende Berücksichtigung dyadischer Aspekte identifiziert.


      Die Übersicht verweist auf verschiedene konzeptuelle und psychometrische Probleme, die in zukünftigen Untersuchungen berücksichtigt werden müssen. Es werden Anregungen für weitere Forschungsarbeiten gegeben.

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