Schwerpunkt| Volume 106, ISSUE 4, P253-263, 2012

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A latent variable framework for modeling dyadic measures in research on shared decision-making


      The aim of our study is to introduce a statistical framework using latent variable modeling for the investigation of correspondence between patients’ and physicians’ perceptions that were measured using dyadic instruments. This statistical approach combines multitrait-multimethod and measurement invariance methodologies. In an illustrative example we used a sample of 285 primary care consultations on chronic diseases to test correspondence between patients’ and physicians’ views on the process of shared decision-making (SDM), which was measured by the patient and physician version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9 and SDM-Q-Doc), respectively. We revealed that while patients and physicians seem to agree on what is the core of SDM, they differ in their ratings regarding to which extent it is present in a certain consultation. The described statistical approach provides important insights into correspondence between perceptions of different stakeholders that cannot be gained using traditional approaches. However, its generalizability is questionable due to the partly explorative data-driven approach and its flexibility is limited by the requirement of samples including at least 200 cases.


      Das Ziel der vorliegenden Studie ist die Vorstellung einer statistischen Analysemethode zur Untersuchung der Übereinstimmung zwischen mehreren Beobachtern in der Forschung zur Partizipativen Entscheidungsfindung. Diese Methode nutzt die Modellierung latenter Variablen und kann als eine Kombination von Multitrait-Multimethod- und Messinvarianz-Analysen verstanden werden. Das Verfahren wird anhand eines Beispiels erläutert, in dem eine Stichprobe von 285 Arzt-Patient-Konsultationen zu chronischen Erkrankungen untersucht wurde. Sowohl die Patienten als auch die Ärzte wurden gebeten, den in der Konsultation erlebten Entscheidungsprozess mittels der Patienten- bzw. der Arztversion des Fragebogens zur Partizipativen Entscheidungsfindung (PEF-FB-9 und PEF-FB-Doc) zu beurteilen. Die Ergebnisse zeigen, dass Patienten und Ärzte weitgehend darin übereinstimmen, was PEF ist. Allerdings beurteilen sie das Ausmaß an PEF in den erlebten Konsultationen substanziell unterschiedlich. Die vorgestellte Analysemethode führte zu Erkenntnissen, die mittels herkömmlicher Analysemethoden nicht hätten gewonnen werden können.

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        • Charles C.
        • Gafni A.
        • Whelan T.
        Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango).
        Soc Sci Med. 1997; 44: 681-692
        • Makoul G.
        • Clayman M.L.
        An integrative model of shared decision making in medical encounters.
        Patient Educ Couns. 2006; 60: 301-312
        • Moumjid N.
        • Gafni A.
        • Brémond A.
        • Carrère M.-O.
        Shared decision making in the medical encounter: are we all talking about the same thing?.
        Med Decis Making. 2007; 27: 539-546
        • Scholl I.
        • Koelewijn-van Loon M.
        • Sepucha K.
        • Elwyn G.
        • Légaré F.
        • Härter M.
        • et al.
        Measurement of shared decision making - a review of instruments.
        Z Evid Fortbild Qual Gesundhwes. 2011; 105: 313-324
        • Härter M.
        • van der Weijden T.
        • Elwyn G.
        Policy and practice developments in the implementation of shared decision making: an international perspective.
        Z Evid Fortbild Qual Gesundhwes. 2011; 105: 229-233
        • Borsboom D.
        • Mellenbergh G.J.
        • van Heerden J.
        The theoretical status of latent variables.
        Psychol Rev. 2003; 110: 203-219
        • Borsboom D.
        Latent variable theory.
        Measurement. 2008; 6: 25-53
        • Härter M.
        [Shared decision making - from the point of view of patients, physicians and health politics is set in place]. [German].
        Z Arztl Fortbild Qualitatssich. 2004; 98: 89-92
        • O’Connor A.
        Progress and prospects in shared decision making.
        in: 6th International Shared Decision Making Conference, MaastrichtJune 2011
        • Olson D.P.
        • Windish D.M.
        Communication discrepancies between physicians and hospitalized patients.
        Arch Intern Med. 2010; 170: 1302-1307
        • Kenny D.A.
        • Veldhuijzen W.
        • Weijden T. van der
        • Leblanc A.
        • Lockyer J.
        • Légaré F.
        • et al.
        Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication.
        Soc Sci Med. 2010; 70: 763-768
        • Behrend L.
        • Maymani H.
        • Diehl M.
        • Gizlice Z.
        • Cai J.
        • Sheridan S.L.
        Patient-physician agreement on the content of CHD prevention discussions.
        Health Expect. 2011; 14: 58-72
        • Saba G.W.
        • Wong S.T.
        • Schillinger D.
        • Fernandez A.
        • Somkin C.P.
        • Wilson C.C.
        • et al.
        Shared decision making and the experience of partnership in primary care.
        Ann Fam Med. 2006; 4: 54-62
        • Ford S.
        • Schofield T.
        • Hope T.
        Observing decision-making in the general practice consultation: who makes which decisions?.
        Health Expect. 2006; 9: 130-137
        • Tinsley H.E.
        • Weiss D.J.
        Interrater reliability and agreement of subjective judgments.
        J Couns Psychol. 1975; 22: 358-376
        • Hirsch O.
        • Keller H.
        • Albohn-Kühne C.
        • Krones T.
        • Donner-Banzhoff N.
        Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research.
        BMC Med Res Methodol. 2011; 11: 71
        • Belkora J.
        • Moore D.H.
        • Hutton D.W.
        Assessing risk communication in breast cancer: are continuous measures of patient knowledge better than categorical?.
        Patient Educ Couns. 2009; 76: 106-112
        • LeBlanc A.
        • Kenny D.A.
        • O’Connor A.M.
        • Légaré F.
        Decisional conflict in patients and their physicians: a dyadic approach to shared decision making.
        Med Decis Making. 2009; 29: 61-68
        • Kriston L.
        • Scholl I.
        • Hölzel L.
        • Simon D.
        • Loh A.
        • Härter M.
        The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample.
        Patient Educ Couns. 2010; 80: 94-99
      1. Scholl I, Kriston L, Dirmaier J, Buchholz A, Härter M. Development and psychometric properties of the Shared Decision Making Questionnaire - Physician Version (SDM-Q-Doc). Patient Educ Couns (in print).

        • Campbell D.T.
        • Fiske D.W.
        Convergent and discriminant validation by the multitrait-multimethod matrix.
        Psychol Bull. 1959; 56: 81-105
        • Marsh H.W.
        Confirmatory factor analyses of multitrait-multimethod data: many problems and a few solutions.
        Appl Psychol Measurement. 1989; 13: 335-361
        • Hoyle R.H.
        • Smith G.T.
        Formulating clinical research hypotheses as structural equation models: a conceptual overview.
        J Consult Clin Psychol. 1994; 62: 429-440
        • Meredith W.
        • Teresi J.A.
        An essay on measurement and factorial invariance.
        Med Care. 2006; 44: S69-S77
        • French B.F.
        • Finch W.H.
        Confirmatory factor analytic procedures for the determination of measurement invariance.
        Struct Equation Model Multidiscip J. 2006; 13: 378-402
        • Vandenberg R.J.
        • Lance C.E.
        A review and synthesis of the measurement invariance literature: suggestions, practices, and recommendations for organizational research.
        Org Res Methods. 2000; 3: 4-70
        • Satorra A.
        • Bentler P.M.
        Corrections to test statistics and standard errors in covariance structure analysis.
        in: von Eye A. Clogg C.C. Latent variables analysis: Applications for developmental research. Sage, Thousand Oaks, CA1994: 399-419
        • Schermelleh-Engel K.
        • Moosbrugger H.
        • Müller H.
        Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures.
        Meth Psych Res Online. 2003; 8: 23-74
        • Hu L.
        • Bentler P.M.
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equation Model Multidiscip J. 1999; 6: 1-55
        • Hair J.F.
        • Black W.C.
        • Babin B.J.
        • Anderson R.E.
        Multivariate Data Analysis. 7. Aufl.
        Prentice Hall, Upper Saddle River, New Jersey2009
        • Satorra A.
        • Bentler P.M.
        A scaled difference chi-square test statistic for moment structure analysis.
        Psychometrika. 2001; 66: 507-514
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Entwistle V.
        • Prior M.
        • Skea Z.C.
        • Francis J.J.
        Involvement in treatment decision-making: its meaning to people with diabetes and implications for conceptualisation.
        Soc Sci Med. 2008; 66: 362-375
        • Thomson R.
        • Elwyn G.
        Implementation of shared decision making in practice. Emerging learning from MAGIC, a UK implementation study.
        in: 6th International Shared Decision Making Conference, MaastrichtJune 2011
      2. NHS East of England. What is Shared Decision Making? Available at: Accessed on 02.09.2011.

        • Elwyn G.
        • Miron-Shatz T.
        Deliberation before determination: the definition and evaluation of good decision making.
        Health Expect. 2010; 13: 139-147
        • Rise M.B.
        • Solbjør M.
        • Lara M.C.
        • Westerlund H.
        • Grimstad H.
        • Steinsbekk A.
        Same description, different values. How service users and providers define patient and public involvement in health care.
        Health Expect. 2011; ([Epub ahead of print] doi:10.1111/j.1369-7625.2011.00713.x. Available from: