Summary
Background
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.
Objective
This paper discusses psychometric and methodological characteristics of the OPTION
scale.
Results
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.
Conclusions
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.
Zusammenfassung
Hintergrund
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.
Ziel
In dieser Arbeit werden psychometrische und methodologische Aspekte der OPTION-Skala
diskutiert.
Ergebnisse
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.
Schlussfolgerungen
Die Übersicht verweist auf verschiedene konzeptuelle und psychometrische Probleme,
die in zukünftigen Untersuchungen berücksichtigt werden müssen. Es werden Anregungen
für weitere Forschungsarbeiten gegeben.
Key words
Schlüsselwörter
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© 2012 Published by Elsevier Inc.
