Validity and reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in a national survey in Hungary

Developing and Evaluating SEE-Diabetes: A Patient-Centered Educational Decision Support System for Diabetes Car

OBJECTIVES

This feasibility study evaluated the effectiveness of Support-Engage-Empower-Diabetes (SEE-Diabetes), a patient-centered educational tool designed to promote shared decision-making of diabetes management in older adults. We aimed to assess SEE-Diabetes's ability to facilitate patient engagement and collaborative goal setting, as measured by the Observational Patient Involvement (OPTION) scale and Shared Decision-Making Questionnaire (SDM-Q-Doc). We hypothesized that these instruments would effectively differentiate between healthcare providers who actively leveraged SEE-Diabetes to guide patient-centric conversations and set goals compared to those who did not.

METHODS

SEE-Diabetes, developed through a 4-year user-centered design process, was employed in simulated clinical encounters at the University of Missouri Health Care. We conducted an analysis of 12 clinical encounters using video recordings. This analysis involved three simulated patients and four providers, two internals and two externals, utilizing a mixed-methods approach. We assessed the decision-making process using SEE-Diabetes by SDM-Q-Doc, OPTION scale, and conversation analysis.

RESULTS

The average scores for the SDM-Q-Doc and the OPTION scale, out of a possible 100, were 52.6 and 75.9, respectively. Our findings revealed that active provider engagement with SEE-Diabetes during patient interactions served as an effective medium to facilitate shared decision-making and to set patient-centered goals. Providers who actively utilized SEE-Diabetes to guide conversations, ask open-ended questions, and incorporate patient input into goal setting demonstrated significantly higher OPTION and SDM-Q-Doc scores compared to those who used the tool less frequently or primarily for documentation purposes. Providers expressed positive feedback, highlighting its conciseness, patient-centricity, and optimism about integrating SEE-Diabetes into their future practices.

CONCLUSION

SEE-Diabetes showed considerable promise in improving interactions between patients and providers, presenting an innovative approach to diabetes management for older adults. This tool has the potential to not only close communication gaps but also enable patients to take a more active role in their healthcare decisions.

Shared decision-making in healthcare: development and assessment of the translated Finnish version of the SDM-Q-9

AIMS

The aim of this study was to assess the cultural validity and reliability of a Finnish version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) in a sample of patients with different sociodemographic characteristics.

METHOD

The original SDM-Q-9 was translated into Finnish with the agreement of the developers of the original scale. The standardised translation procedure was followed by a pilot test of the questionnaire. The data were collected from an online questionnaire. Reliability was estimated by Cronbach's alpha. Structural validity of the questionnaire was assessed by confirmatory factor analysis.

RESULTS

The pilot study assessing the cultural validity of the scale was a success, as it did not find any expressions needing to be revised. The Finnish version of the SDM-Q-9 - the SDM-Q-9-FIN - was tested in the study where a total of 736 patients responded to the questionnaire. The questionnaire yielded high reliability with a Cronbach's alpha of 0.92. Confirmatory factor analysis confirmed the unidimensional factor structure with Item 1 excluded.

CONCLUSIONS

The SDM-Q-9-FIN was shown to be a reliable instrument for evaluating shared decision-making among Finnish patients. Further testing and research are recommended among a greater diversity of patient groups.

Patient leaflets on respiratory tract infections did not improve shared decision making and antibiotic prescriptions in a low-prescriber setting

Patient information leaflets can reduce antibiotic prescription rates by improving knowledge and encouraging shared decision making (SDM) in patients with respiratory tract infections (RTI). The effect of these interventions in antibiotic low-prescriber settings is unknown. We conducted a pragmatic pre-/post interventional study between October 2022 and March 2023 in Swiss outpatient care. The intervention was the provision of patient leaflets informing about RTIs and antibiotics use. Main outcomes were the extent of SDM, antibiotic prescription rates, and patients' awareness/knowledge about antibiotic use in RTIs. 408 patients participated in the pre-intervention period, and 315 patients in the post- intervention period. There was no difference in the extent of SDM (mean score (range 0-100): 65.86 vs. 64.65, p = 0.565), nor in antibiotic prescription rates (no prescription: 89.8% vs. 87.2%, p = 0.465) between the periods. Overall awareness/knowledge among patients with RTI was high and leaflets showed only a small effect on overall awareness/knowledge. In conclusion, in an antibiotic low-prescriber setting, patient information leaflets may improve knowledge, but may not affect treatment decisions nor antibiotic prescription rates for RTIs.

Shared decision making in the treatment of pediatric strabismus

PURPOSE

To quantify the results of shared decision making in pediatric strabismus surgery from the parent perspective using the nine-item Shared Decision Making (SDM) Questionnaire and the associations of SDM score with parental education level; secondarily, to evaluate postoperative parental satisfaction as a function of child age, parental education level, SDM scores, and motor outcomes.

METHODS

Consecutive parents of children 2-14 years of age with concomitant manifest strabismus that consented to strabismus surgery were surveyed using the SDM Questionnaire. A four-point Likert scale was used to gauge the level of postoperative satisfaction (POS). Potential predictors were estimated in multivariable regression analysis, with results adjusted for education level, children's age, and motor outcomes.

RESULTS

A total of 100 parents (86 women) completed the survey and were included. Significant differences for SDM score were found between individuals with university-level versus the other three educational levels (P < 0.001 for primary and secondary levels; P = 0.017 for college or lyceum level). Categorical regression analysis showed that POS level was inversely correlated with education level and positively correlated with SDM score. Children's age at time of surgery and postoperative motor outcome were not significantly associated with POS.

CONCLUSIONS

In our study cohort, SDM score was correlated with educational level. Satisfaction was greater among responders with higher SDM scores, indicating that SDM may help improve parent-reported satisfaction with treatment results.

Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China

BACKGROUND

Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participation of patients with chronic diseases in SDM on medication.

METHODS

A total of 1,196 patients with chronic diseases were selected in Hubei Province of China using cluster sampling methods. The random forest method was applied to rank the importance of independent variables by Mean Decrease Gini and out-of- bag (OOB) curve. Multivariate logistic regression was used to explore the independent variables' effect direction and relative hazard.

RESULTS

In this study, 5.18% of patients used patient-directed decision making (PDM, a decision-making model led by patients), 37.79% of patients used SDM (a collaborative decision-making model by patients and doctors), and 57.02% of patients used doctor-directed decision making (DDM, or paternalistic decision making, a decision-making model led by doctors). The random forest analysis demonstrated that the top 5 important factors were age, education, exercise, disease course, and medication knowledge. The OOB curve showed that the error rate reached minimum when top 5 variables in importance ranking composed an optimal variable combination. In multivariate logistic regression, we chose SDM as a reference group, and identified medication knowledge (OR = 2.737, 95%CI = 1.524 ~ 4.916) as the influencing factor between PDM and SDM. Meanwhile, the influencing factors between DDM and SDM were age (OR = 0.636, 95%CI = 0.439 ~ 0.921), education (OR = 1.536, 95%CI = 1.122 ~ 2.103), exercise (OR = 1.443, 95%CI = 1.109 ~ 1.877), disease course (OR = 0.750, 95%CI = 0.584 ~ 0.964), and medication knowledge (OR = 1.446, 95%CI = 1.120 ~ 1.867).

CONCLUSION

Most Chinese patients with chronic diseases used DDM during their medication decision-making, and some patients used PDM and SDM. The participation in SDM should be taken seriously among elderly patients with lower education levels. The SDM promotion should focus on transformation of patients' traditional perception and enhance their medication knowledge.

Shared Decision Making for Choosing renAl Replacement Therapy in Chronic Kidney Disease Patients (SDM-ART trial): study protocol for randomized clinical trial

BACKGROUND

Patients with chronic kidney disease (CKD) should be educated about their condition so that they can initiate dialysis at the optimal time and make an informed choice between dialysis modalities. Shared decision-making (SDM) empowers patients to select their own treatment and improves patient outcomes. This study aimed to evaluate whether SDM affects the choice of renal replacement therapy among CKD patients.

METHODS

This is a multicenter, open-label, randomized, pragmatic clinical trial. A total of 1,194 participants with CKD who are considering renal replacement therapy were enrolled. The participants will be randomized into three groups in a 1:1:1 ratio: the conventional group, extensive informed decision-making group, and SDM group. Participants will be educated twice at months 0 and 2. Videos and leaflets will be provided to all patients. Patients in the conventional group will receive 5 minutes of education at each visit. The extensive informed decision-making group will receive more informed and detailed education using intensive learning materials for 10 minutes each visit. Patients in the SDM group will be educated for 10 minutes each visit according to illness perception and item-based analysis. The primary endpoint is the ratio of hemodialysis to peritoneal dialysis and kidney transplantation among the groups. Secondary outcomes include unplanned dialysis, economic efficiency, patient satisfaction, patient evaluation of the process, and patient adherence.

DISCUSSION

The SDM-ART is an ongoing clinical study to investigate the effect of SDM on the choice of renal replacement therapy in patients with CKD.

Women's Involvement in Decision-Making and Associated Factors Among Women Who Underwent a Caesarean Section in Sidama Region, South Ethiopia: Cross-Sectional Study

Background

A caesarean delivery without maternal involvement in decision-making reduces the quality of health care and breaks women's autonomy. However, the involvement of women in decision-making to have a caesarean delivery is minimal. Still, now paternalism is widely practised. The study aims to assess women's involvement in decision-making and associated factors among women who underwent a caesarean delivery.

Methods

Institutional-based cross-sectional study was conducted in Sidama region Public hospitals from June 22/2022-August 5/2022, among women who underwent a caesarean delivery. The total sample size was 457. The collected data was exported from the ODK toolbox server to excel and then to SPSS version 26 for further data cleaning and analysis. The variables with a p-value ≤ 0.25 in the bivariable analysis were included in a multivariable ordinal logistic regression model to control possible confounders. The resulting odds ratio and 95% confidence interval were computed, and a p-value of less than 0.05 is considered statistically significant.

Results

Women's agreed decision-making involvement to have a caesarean delivery is 165(37.9%). Women who had an scheduled caesarean delivery [AOR: 7.6; 95% CI: 3.3, 17.8], had adequate information about caesarean delivery [AOR: 5.7; 95% CI:3.3, 10.0], had adequate time for decision-making [AOR: 4.6; 95% CI:2.09, 6.4], language of consent [AOR: 1.9; 95% CI: 1.2, 3.1], and women-healthcare providers relationship [AOR: 5.2; 95% CI: 3.2, 8.6]are higher odds of being involved in decision-making, but women's being primary school [AOR: 0.53; 95% CI: 0.3,0.97] are lower odds of involvement in decision-making to have a caesarean delivery.

Conclusion and recommendation

In this study, women's agreed decision-making involvement to have a caesarean delivery is low compared with other studies. Women-healthcare providers' relationship and an unscheduled caesarean delivery are highly affect their involvement in decision-making. Therefore, hospitals should translate and prepare the consent form in an understandable way for women and families, and healthcare providers should develop good relationship and encourage her involvement.

Is shared decision-making a determinant of polypharmacy in older patients with chronic disease? A cross-sectional study in Hubei Province, China

BACKGROUND

Shared decision-making(SDM) is recognized as an important means of managing polypharmacy among older people with chronic diseases. However, no studies have quantitatively measured the effect of SDM on polypharmacy. The objective of this study was to compare the impact of SDM and other factors on polypharmacy in inpatients and community patients. Additionally, the study aimed to compare the impact of different decision types on polypharmacy in community patients.

METHODS

This is a population-based multicenter retrospective study conducted in Hubei Province, China. A cluster sampling approach was used to recruit 536 chronic disease inpatients from March to April 2019, and 849 community patients were recruited from April to June 2021. Propensity score weighting was used to control the confounding variables and determine the net effect of SDM on polypharmacy.

RESULTS

Among the 536 hospitalized patients, the prevalence of polypharmacy was 56.3%. A high level of SDM was significantly associated with a lower risk of polypharmacy. Patients with chronic illnesses aged 76 years and older and with an annual family income of 24,001-36,000 yuan were associated with a lower likelihood of polypharmacy (p < 0.05). Multimorbidity was often accompanied by the occurrence of multiple medication use. Among 849 community patients, the prevalence of polypharmacy was 21.8%. Among types of decision-making, informed and paternalistic decision-making showed a higher likelihood of polypharmacy compared with shared decision-making (P < 0.05). Male, older patients over 76 years of age, urban residents, annual household income of 12,001-24,000 yuan, and multimorbidity were associated with higher likelihood of polypharmacy (P < 0.05). Patients with an annual household income of 24,001-36,000 yuan, 36,001 yuan or more, and good medication compliance showed a lower likelihood of polypharmacy (P < 0.05).

CONCLUSIONS

The prevalence of polypharmacy is high among China's older population with chronic disease who should be paid more atthention by the healthcare providers. Additionaly, encouraging the patients' attendance in SDM, reducing paternalistic and informed decision-making during prescribing, improving patient medication compliance, and increasing the promotion and guidance of rational medication use for patients are essential to reduce polypharmacy in Chinese chronic disease patients.

Evaluating Shared Decision-Making in Treatment Selection for Dupuytren Contracture: A Mixed Methods Approach

BACKGROUND

Patients with Dupuytren contracture can receive a variety of surgical and nonsurgical treatments. The extent to which patients participate in the shared decision-making process is unclear.

METHODS

An explanatory-sequential mixed-methods study was conducted. Participants completed the Nine-Item Shared Decision-Making Questionnaire and the brief Michigan Hand Outcomes Questionnaire before completing semi-structured interviews in which they described their experience with selecting treatment.

RESULTS

Thirty participants [25 men (83%) and five women (17%); mean age, 69 years (range, 51 to 84 years)] received treatment for Dupuytren contracture (11 collagenase injection, six needle aponeurotomy, and 13 limited fasciectomy). Adjusted mean scores for the Shared Decision-Making Questionnaire and brief Michigan Hand Outcomes Questionnaire were 71 (SD 20) and 77 (SD 16), respectively, indicating a high degree of shared decision-making and satisfaction. Patients who received limited fasciectomy accepted invasiveness and prolonged recovery time because they believed it provided a long-term solution. Patients chose needle aponeurotomy and collagenase injection because the treatments were perceived as safer and more convenient and permitted rapid return to daily activities, which was particularly valued by patients who were employed or had bilateral contractures.

CONCLUSIONS

Physicians should help patients choose a treatment that aligns with the patient's preferences for long-term versus short-term results, recovery period and postoperative rehabilitation, and risk of complications, because patients used this information to assist in their treatment selection. Areas of improvement for shared decision-making include equal presentation of all treatments and ensuring realistic patient expectations regarding the chronic and recurrent nature of Dupuytren contracture regardless of treatment received.

Effectiveness of interprofessional shared decision-making training: A mixed-method study

OBJECTIVE

This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program.

METHODS

This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules.

RESULTS

A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork.

CONCLUSION

This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM.

PRACTICE IMPLICATIONS

Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.

Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers

Shared decision-making (SDM) has been institutionally recognized as clinically effective by many Western healthcare systems. Nevertheless, it appears culturally unattractive in China, a country that adheres to Confucian familism which strongly prefers collective family decisions. This study examined this conflict and assessed the influence of Confucian familism on SDM in end-of-life (EOL) care for advanced cancer patients. Between August and November 2018, 188 EOL advanced-cancer patients were randomly recruited from 640 cancer hospital medical records at a Tertiary A-level hospital in Shandong province. Eventually, 164 (87.23%) sample patients were included in the statistical analysis after the non-responsive cases (4.79%) and missing value (7.98%) were removed. SDM was measured through SDM-Q-9, and the patient's siblings were used as indicators of Confucian Familism. Of the 164 patients, the mean SDM score was 38/100; 47.6% were thoroughly unfamiliar with their treatment plans and fell outside the decision-making procedure. Each patient had four siblings on average. Ceteris paribus, more siblings led to lower SDM. Moreover, being 56-65 years old and open-minded were associated with higher SDM, while higher satisfaction of the quality of EOL care yielded lower SDM. In conclusion, Confucian familism weakened patient-clinician SDM in EOL care for advanced cancer patients.

Psychometric Properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9): Validation of the Italian Version in a Large Psychiatric Clinical Sample

OBJECTIVE

The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) is one of the most frequently used tools for assessing patients' involvement in medical decision-making, but so far, it not been validated in Italian. We aimed to validate the Italian version of the SDM-Q-9 in a clinical sample of patients suffering from major psychiatric disorders.

METHOD

We involved 307 consecutive patients affected by major psychiatric disorders (including schizophrenia spectrum disorders, affective disorders and eating disorders) in a real-world outpatient clinical setting. Confirmatory Factor Analysis (CFA) was conducted to examine the latent structure of the SDM-Q-9. Cronbach's alpha and correlations between the SDM-Q-9 and the Observing Patient Involvement (OPTION) scale were calculated to measure internal consistency and convergent validity respectively.

RESULTS

The final sample was made up of 289 participants (response rate 94.1%) who completed the assessment. CFA confirmed the unidimensional structure as in the original version (χ2/df= 1.69; CFI= 0.98; TLI= 0.97; RMSEA= 0.05; SRMR= 0.08). Internal consistency of the total scale was Cronbach's α = .86. Regarding construct validity, we found several correlations between the SDM-Q-9 and OPTION scale.

CONCLUSIONS

Our findings suggest that the Italian version of SDM-Q-9 performs well if compared to other languages validated versions, so it is a useful patient-centred measure to assess the involvement in medical decision-making (SDM) of patients from clinical samples from the Italian-speaking population.

Comparison of the CollaboRATE and SDM-Q-9 questionnaires to appreciate the patient-reported level of shared decision-making

OBJECTIVE

To compare CollaboRATE and SDM-Q-9 questionnaires when appreciating patient-perceived level of shared decision-making (SDM) in doctor-patient consultations.

METHODS

Data were harvested from five separate studies on SDM, conducted in three university and one large community hospital in the Netherlands, using Dutch versions of both questionnaires. CollaboRATE and SDM-Q-9 scores were expressed as percentages. Correlation was assessed using Spearman's Rho coefficient. Bland&Altman analysis was used to assess the degree of agreement. Top scores were calculated to assess possible ceiling effects.

RESULTS

The five studies included 442 patients. Median CollaboRATE scores (88.9%, IQR 81.5-100%) were significantly higher (p < 0.001) than SDM-Q-9 scores (80.0%, IQR 64.4-100%). Correlation was moderate (Rho=0.53, p < 0.001). A systematic, 12.5-point higher score was found across the range of scores when using CollaboRATE. Top scores for CollaboRATE and SDM-Q-9 were present in 37.5% and 17% of questionnaires, respectively.

CONCLUSIONS

Overall, CollaboRATE and SDM-Q-9 questionnaires showed a high level of patient-perceived SDM. However, CollaboRATE only moderately correlated with SDM-Q-9 and had a stronger ceiling effect.

PRACTICE IMPLICATIONS

When choosing a SDM-measurement tool, its benefits and limitations should be weighed. These metrics should be combined with objective scores of SDM, as these may differ from the patients' subjective interpretation.

Patient-centred care in Hungary: Contributions to foster a policy agenda

In Hungary, the National Health Insurance Fund provides health care coverage for nearly all residents, but healthcare spending is below the EU's average (6.4% versus 9.9% of the GDP in 2019, respectively). In 1997, patients' rights were established by laws of the healthcare system. The patients' voice, however, has remained weakly embedded in decision-making processes both on the system and individual patient levels. Policy progress achieved in the past years may foster patient-centeredness in health policy decision-making. However, people-reported data are not yet embedded in the Hungarian health information system and national population or household surveys, thus undermining the monitoring of the performance of the health system regarding patient-centred aspects. From the academic research side, several advances have occurred regarding the availability of validated instruments for the measurement of patient-centred aspects. These recent studies have placed Hungary in a uniquely advanced position compared with other countries in the Central and Eastern European (CEE) region. The use of those instruments in clinical guidelines and practices, to the education curricula of future health workers, is still in an early stage.

Does the SDMQ-9 Predict Changes in HbA1c Levels? An Ecuadorian Cohort

Background and Objectives: Diabetes mellitus affects 422 million people around the world, positioning it as a major health problem. According to the WHO(World Health Organization), 90% corresponds to type 2. The shared-decision making (SDM) is a method used to facilitate patient control, medication, maintenance, and assessment of health status according to their priorities and preferences. With the application of SDM in patients with diabetes, it is expected there will be an increase in treatment adherence and a reduction in HbA1c levels. The aim of this study is to determine the predictors of the change in HbA1c. Material and Methods: A sample of 76 participants attending as endocrinology outpatients was obtained. Data collected within the sample included: sex, age, educational level, body mass index, and the level of SDM using the SDMQ-9. In addition, HbA1c levels were measured twice: at baseline and three months after the first measurement. Results: The linear regression indicates that the level of SDM is a significant predictor of the change in HbA1c, specifically in men. However, the direction of the relationship was a somewhat opposite trend than we expected. Higher levels of SDM imply an increase in HbA1c rather than a reduction. Conclusions: Contrary to the literature, our results shows that elevated levels of perceived SDM may be associated with worse diabetic control. However, more investigation is needed as these results are not generalizable, due to the specific population used and the sample size. Furthermore, to better understand the effect of SDM on the change in HbA1c in patients with poorly controlled diabetes.

Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions

This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts' opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.

Shared decision making and patients satisfaction with strabismus care-a pilot study

BACKGROUND

Strabismus is a complex disease that has various treatment approaches each with its own advantages and drawbacks. In this context, shared decisions making (SDM) is a communication process with the provider sharing all the relevant treatment alternatives, all the benefits, and risks of each procedure, while the patient shares all the preferences and values regarding his/her choices. In that way, SDM is a bidirectional process that goes beyond the typical informed consent. Therefore, it is known a little of the extent to which SDM influences the satisfaction with the treatment outcome along with strabismus patients. To study this correlation, an SDM-Q-9 questionnaire was provided within surgical consultations where treatment decisions were made; the SDM-Q-9 aims to assess the relationship between the post-operative patient's satisfaction and their SMD score.

METHODS

The study is considered a prospective observational pilot study. Eligible patients were adult patients diagnosed with strabismus, who had multiple treatment options, were given at the right of choice without being driven into a physician's preference. Ninety-three strabismus patients were asked to fill out the SDM-Q-9 questionnaire related to their perception of SDM during the entire period of strabismus treatment. After the treatment, patients were asked to rate their satisfaction level with the surgical outcome as excellent, good, fair, and poor. Descriptive statistics and the linear regression statistical tests (Spearman, Mann Whitney U, and Kriskal-Wallis) were used as analysis tools.

RESULTS

The average age of the participants was 24, where 50.6% were women. The mean SDM-Q-9 score among patients was 32 (IQR = 3). The postoperative patient satisfaction was rated as being excellent by 16 (17.2%) patients, good by 38 (40.9%), fair by 32 (34.4%), and poor by 7 patients (7.5%). Data analysis by linear regression statistical tests showed a positive correlation between the SDM-Q-9 score and the patient satisfaction related to the surgery outcome (B = 0.005, p < 0.001). Criteria in assessing patients' satisfaction were age, gender, and strabismus type. A positive correlation between SDM and real satisfaction (r = 0.834, p < 0.01) was found with age, and no significant relationship was found while taking into consideration the responder's gender and the strabismus type.

CONCLUSIONS

Assessing patient satisfaction after choosing a treatment for strabismus method helped us evaluate the gaps in constructive dialogue that would lead to a positive outcome for both patient and clinician. The correlation between the SDM process and the patients' satisfaction with surgery outcome, adjusted by age, has been established. These findings can serve as a springboard to further communicative improvements related to the SDM process and between patients and physicians, thereby consequently leading to patients' satisfaction raise in strabismus care. The study underlines the importance of further analysis and validation of on-ground interactions among the adolescent and adult patients and the clinicians across the strabismus management trajectory. A multicentral study and its validation will follow.

Self-Reported Waiting Times for Outpatient Health Care Services in Hungary: Results of a Cross-Sectional Survey on a National Representative Sample

(1) Background: System-level data on waiting time in the outpatient setting in Hungary is scarce. The objective of the study was to explore self-reported waiting time for an appointment and at a doctor’s office. (2) Methods: An online, cross-sectional, self-administered survey was carried out in 2019 in Hungary among a representative sample (n = 1000) of the general adult population. Chi-squared test and logistic regression analysis were carried out to explore if socioeconomic characteristics, health status, or residence were associated with waiting times and the perception of waiting time as a problem. (3) Results: Proportions of 90%, 41%, and 64% of respondents were seen within a week by family doctor, public specialist, and private specialist, respectively. One-third of respondents waited more than a month to get an appointment with a public specialist. Respondents in better health status reported shorter waiting times; those respondents were less likely to perceive a problem with: (1) waiting time to get an appointment (OR = 0.400) and (2) waiting time at a doctor’s office (OR = 0.519). (4) Conclusions: Longest waiting times were reported for public specialist visits, but waiting times were favorable for family doctors and private specialists. Further investigation is needed to better understand potential inequities affecting people in worse health status.

Did You Get What You Wanted? Patient Satisfaction and Congruence Between Preferred and Perceived Roles in Medical Decision Making in a Hungarian National Survey

OBJECTIVES

In a growing number of countries, patient involvement in medical decisions is considered a cornerstone of broader health policy agendas. This study seeks to explore public preferences for and experiences with participation in treatment decisions in Hungary.

METHODS

A nationally representative online panel survey was conducted in 2019. Outcome measures included the Control Preferences Scale for the preferred and actual role in the decision, the 9-item Shared Decision Making Questionnaire, and a Satisfaction With Decision numeric rating scale.

RESULTS

A total of 1000 respondents participated in the study, 424 of whom reported having had a treatment decision in the preceding 6 months. Overall, 8%, 18%, 51%, 19%, and 4% of the population preferred an active, semiactive, shared, semipassive, and passive role in decision making, respectively. Corresponding rates for perceived role were as follows: 9%, 15%, 35%, 26%, and 15%. Preferred and perceived roles matched for 52% of the population, whereas 32% preferred more and 16% less participation. Better health status, attaining role congruence, and higher 9-item Shared Decision Making Questionnaire scores were positively associated with satisfaction, accounting for 32% of the variation in Satisfaction With Decision scores (P < .05).

CONCLUSIONS

This study represents the first national survey on decisional roles in healthcare in Hungary and, more broadly, in Central and Eastern Europe. Shared decision making is the most preferred decisional role in Hungary; nevertheless, there is still room to improve patient involvement in decision making. It seems that patient satisfaction may be improved through tailoring the decisional role to reflect patients' preferences and through practices that encourage shared decision making.

Exploring eHealth Literacy and Patient-Reported Experiences With Outpatient Care in the Hungarian General Adult Population: Cross-Sectional Study

BACKGROUND

Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine toward people-centeredness. Thus, eHealth literacy, assisted by innovative digital health solutions, may support better experiences of care.

OBJECTIVE

The purpose of this study is to explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary.

METHODS

In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS). PREMs with outpatient care were measured with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD) for respondents who attended outpatient visit within 12 months preceding the survey. Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test, and chi-square test. To capture nonlinear associations, after controlling covariates, we analyzed the relationship between eHEALS quartiles and PREMs using multivariate probit, ordinary least squares, ordered logit, and logistic regression models.

RESULTS

From 1000 survey respondents, 666 individuals (364 females, 54.7%) were included in the study with mean age of 48.9 (SD 17.6) years and mean eHEALS score of 29.3 (SD 4.9). Respondents with higher eHEALS scores were more likely to understand the health care professionals' (HCPs') explanations (χ29=24.2, P=.002) and to be involved in decision making about care and treatment (χ29=18.2, P=.03). In multivariate regression, respondents with lowest (first quartile) and moderately high (third quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.02) and experience fewer problems (P=.02). In addition, those respondents had better experiences in terms of how easy it was to understand the HCPs' explanations (P<.001) and being able to ask questions during their last consultation (P=.04). Patient-reported experiences of individuals with highest (fourth quartile) and lowest (first quartile) eHEALS levels did not differ significantly in any items of the PREM instrument, and neither did composite PREM scores generated from the PREM items (P>.05 in all models).

CONCLUSIONS

We demonstrated the association between eHealth literacy and PREMs. The potential patient-, physician-, and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation, which may contribute to the development of efficient eHealth literacy interventions. Further research is needed to establish causal relationship between eHealth literacy and patient-reported experiences.

Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions

BACKGROUND

Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas.

OBJECTIVE

This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States.

METHODS

A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States.

RESULTS

A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation.

CONCLUSIONS

The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

Eliciting preferences for outpatient care experiences in Hungary: A discrete choice experiment with a national representative sample

Introduction

Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens’ health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients’ preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings.

Methods

A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD’s standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space.

Results

The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents’ choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85–5.90) for waiting an hour less at a doctor’s office to €36.13 (32.07–40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not.

Conclusions

A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.