Restricted accessResearch articleFirst published online 2022-4
Relationships among Antecedents,Processes,and Outcomes for Shared Decision Making: A Cross-Sectional Survey of Patients with Lumbar Degenerative Disease
Among musculoskeletal disorders, lumbar degenerative disease (LDD) is the leading cause of total disability-adjusted life years globally. Clinical guidelines for LDD describe multiple treatment options in which shared decision making becomes appropriate.
Objectives
To explore the relationships among measures of decision antecedents, process, and outcomes in patients with LDD.
Methods
Patients with LDD were recruited from outpatient clinics in a teaching hospital in Taiwan and administered surveys to collect measures of decision antecedents, processes, and outcomes. Multiple linear regression was conducted to assess the association between decision antecedents and the decision making process. Hierarchical linear regression was conducted to assess the relationships among decision antecedents, the decision making process, and decision outcomes.
Results
A total of 132 patients (mean age, 61 years) completed the survey. After adjustment for personal factors, 2 decision antecedents (namely, decision making self-efficacy and readiness) significantly predicted patients’ experiences of engaging in shared decision making (SDM). Decision making readiness and process were associated with fewer decisional conflicts and greater decision satisfaction.
Limitations
Models derived from cross-sectional surveys cannot establish causal relationships among decision antecedents, decision making processes, and decision outcomes.
Conclusions
Our results support the SDM framework, which proposes relationships among decision antecedents, the decision making process, and decision outcomes.
WoolfAD. Global burden of osteoarthritis and musculoskeletal diseases. BMC Musculoskelet Disord. 2015;16(suppl 1):S3.
2.
WeiS-H. The Treated Prevalence of Low Back Pain and the Analysis of Spinal Instrumentation in Back Surgery Patients: A National Health Insurance Research Database Analysis. Tunghai: Tunghai University; 2009.
3.
GolobALWipfJE. Low back pain. Med Clin North Am. 2014;98(3):405–28.
4.
KurdMFLurieJDZhaoW, et al. Predictors of treatment choice in lumbar spinal stenosis: a spine patient outcomes research trial study. Spine. 2012;37(19):1702–7.
5.
KimHJParkJYKangKTChangBSLeeCKYeomJS. Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process. Eur Spine J. 2015;24(2):339–47.
6.
Oshima LeeEEmanuelEJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013;368(1):6–8.
7.
WeinsteinJNBronnerKKMorganTSWennbergJE. Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine: is there a roadmap for change?Health Affairs. 2004;23(suppl 2):VAR-81–VAR-9.
8.
BarryMJEdgman-LevitanS. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.
9.
SepuchaKMulleyAGJr.A perspective on the patient’s role in treatment decisions. Med Care Res Rev. 2009;66(1, suppl):53s–74s.
10.
BotAGBossenJKHerndonJHRuchelsmanDERingDVranceanuAM. Informed shared decision-making and patient satisfaction. Psychosomatics. 2014;55(6):586–94.
11.
LechnerSHerzogWBoehlenF, et al. Control preferences in treatment decisions among older adults: results of a large population-based study. J Psychosom Res. 2016;86:28–33.
12.
LegareFO’ConnorAMGrahamIDWellsGATremblayS. Impact of the Ottawa Decision Support Framework on the agreement and the difference between patients’ and physicians’ decisional conflict. Med Decis Making. 2006;26(4):373–90.
13.
NeaseRFJrBrooksWB. Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. J Gen Intern Med. 1995;10(11):593–600.
14.
De Las CuevasCPenateW. Validity of the Control Preferences Scale in patients with emotional disorders. Patient Prefer Adherence. 2016;10:2351–6.
15.
KehlKLLandrumMBAroraNK, et al. Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care. JAMA Oncol. 2015;1(1):50–8.
16.
De las CuevasCPenateW. To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables. Acta Neuropsychiatr. 2014;26(6):372–81.
17.
SepuchaKFeibelmannSChangY, et al. Factors associated with the quality of patients’ surgical decisions for treatment of hip and knee osteoarthritis. J Am Coll Surg. 2013;217(4):694–701.
18.
StaceyDHawkerGDervinG, et al. Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial. BMC Musculoskelet Disord. 2014;15:54.
19.
StaceyDLegareFLewisK, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431.
20.
GlassKEWillsCEHollomanC, et al. Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey. Patient Educ Couns. 2012;88(1):100–5.
21.
LegareFRatteSGravelKGrahamID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73(3):526–35.
22.
Muller-EngelmannMKellerHDonner-BanzhoffNKronesT. Shared decision making in medicine: the influence of situational treatment factors. Patient Educ Couns. 2011;82(2):240–6.
23.
MakoulGClaymanML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006;60(3):301–12.
24.
LeeYKChorYYTanMY, et al. Factors associated with level of shared decision making in Malaysian primary care consultations. Patient Educ Couns. 2020;103(5):1049–51.
25.
LeBlancAKennyDAO’ConnorAMLegareF. Decisional conflict in patients and their physicians: a dyadic approach to shared decision making. Med Decis Making. 2009;29(1):61–8.
26.
HedbergBMalmDKarlssonJEArestedtKBrostromA. Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation. Eur J Cardiovasc Nurs. 2018;17(5):446–55.
27.
ElwynGDurandMASongJ, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891.
28.
LueYJHsiehCLHuangMHLinGTLuYM. Development of a Chinese version of the Oswestry Disability Index version 2.1. Spine. 2008;33(21):2354–60.
BeatonDEBombardierCGuilleminFFerrazMB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91.
31.
LeeSC. Intimacy and family consent: a Confucian ideal. J Med Philosophy. 2015;40(4):418–36.
32.
LaiC-C. Decisional Conflict of Treatment and Associated Factors in Patients with Brain Tumor in Taiwan. Taiwan: National Taiwan University; 2011.
33.
DegnerLFSloanJA. Decision making during serious illness: what role do patients really want to play?J Clin Epidemiol. 1992;45(9):941–50.
34.
DegnerLFSloanJAVenkateshP. The Control Preferences Scale. Can J Nurs Res. 1997;29(3):21–43.
35.
Katie LeeSYKnobfMT. Primary breast cancer decision-making among Chinese American women: satisfaction, regret. Nurs Res. 2015;64(5):391–401.
36.
BunnHO’ConnorA. Validation of client decision-making instruments in the context of psychiatry. Can J Nurs Res. 1996;28(3):13–27.
37.
NgYKShahNMLoongLSPeeLTHidzirSAMChongWW. Attitudes toward concordance and self-efficacy in decision making: a cross-sectional study on pharmacist-patient consultations. Patient Prefer Adherence. 2018;12:615–24.
38.
NielsenBKMehlsenMJensenABZachariaeR. Cancer-related self-efficacy following a consultation with an oncologist. Psychooncology. 2013;22(9):2095–101.
39.
BennettCGrahamIDKristjanssonEKearingSAClayKFO’ConnorAM. Validation of a preparation for decision making scale. Patient Educ Couns. 2010;78(1):130–3.
40.
SchallerSMarinova-SchmidtVSetzerM, et al. Usefulness of a tailored eHealth service for informal caregivers and professionals in the dementia treatment and care setting: the eHealthMonitor Dementia Portal. JMIR Res Protoc. 2016;5(2):e47.
41.
MilesAChronakisIFoxJMayerA. Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation. BMJ Open. 2017;7(3):e012935.
42.
BerryDLWangQHalpennyBHongF. Decision preparation, satisfaction and regret in a multi-center sample of men with newly diagnosed localized prostate cancer. Patient Educ Couns. 2012;88(2):262–7.
43.
DoherrHChristalleEKristonLHarterMSchollI. Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies: a systematic review. PLoS One. 2017;12(3):e0173904.
44.
KristonLSchollIHolzelLSimonDLohAHarterM. The 9-item Shared Decision Making Questionnaire (SDM-Q-9): development and psychometric properties in a primary care sample. Patient Educ Couns. 2010;80(1):94–9.
45.
ElwynGEdwardsAKinnersleyPGrolR. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract. 2000;50(460):892–9.
46.
Rodenburg-VandenbusscheSPieterseAHKroonenbergPM, et al. Dutch translation and psychometric testing of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and Shared Decision Making Questionnaire–Physician Version (SDM-Q-Doc) in primary and secondary care. PLoS One. 2015;10(7):e0132158.
47.
SimonDSchorrGWirtzM, et al. Development and first validation of the shared decision-making questionnaire (SDM-Q). Patient Educ Couns. 2006;63(3):319–27.
48.
WuTYChenCTHuangYJHouWHWangJDHsiehCL. Rasch Analysis of the 9-item Shared Decision Making Questionnaire in women with breast cancer. Cancer Nurs. 2019;42(3):E34–42.
49.
O’ConnorAM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25–30.
50.
LamWWKwokMLiaoQ, et al. Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery. Health Expect. 2015;18(2):210–20.
51.
Holmes-RovnerMKrollJSchmittN, et al. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996;16(1):58–64.
52.
ChabreraCArealJFontACaroMBonetMZabaleguiA. Spanish version of the Satisfaction with Decision scale: cross-cultural adaptation, validity and reliability. Enferm Clin. 2015;25(3):117–23.
53.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Erlbaum; 1988.
54.
Rodriguez-ArduraIMeseguer-ArtolaA. How to prevent, detect and control common method variance in electronic commerce research. J Theoret Appl Electronic Commerce Res. 2020;15:1–5.
55.
RichardsonHASimmeringMJSturmanMC. A tale of three perspectives: examining post hoc statistical techniques for detection and correction of common method variance. Organ Res Methods. 2009;12(4):762–800.
56.
WilliamsLJMcGonagleAK. Four research designs and a comprehensive analysis strategy for investigating common method variance with self-report measures using latent variables. J Business Psychol. 2016;31(3):339–59.
57.
Paiva-SalisburyMLGillADStickleTR. Isolating trait and method variance in the measurement of callous and unemotional traits. Assessment. 2017;24(6):763–71.
58.
RosseelY. lavaan: an R package for structural equation modeling. J Stat Softw. 2012;48(2):1–36.
59.
HsuehIPJengJSLeeYSheuCFHsiehCL. Construct validity of the stroke-specific quality of life questionnaire in ischemic stroke patients. Arch Phys Med Rehabil. 2011;92(7):1113–8.
60.
KlineRB. Principles and Practice of Structural Equation Modeling. New York: Guilford; 2015.
61.
FukuiSSalyersMPMatthiasMS, et al. Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Ment Health J. 2014;50(4):375–82.
62.
SolbergLICrainALRubensteinLUnutzerJWhitebirdRRBeckA. How much shared decision making occurs in usual primary care of depression?J Am Board Fam Med. 2014;27(2):199–208.
63.
SepuchaKFeibelmannSChangYHewittSZiogasA. Measuring the quality of surgical decisions for Latina breast cancer patients. Health Expect. 2015;18(6):2389–400.
64.
HawleySTMorrisAM. Cultural challenges to engaging patients in shared decision making. Patient Educ Couns. 2017;100(1):18–24.
65.
Laidsaar-PowellRButowPBuS, et al. Family involvement in cancer treatment decision-making: a qualitative study of patient, family, and clinician attitudes and experiences. Patient Educ Couns. 2016;99(7):1146–55.
66.
AldenDLFriendJLeePY, et al. Who decides: me or we? family involvement in medical decision making in Eastern and Western countries. Med Decis Making. 2018;38(1):14–25.
67.
GrahamMEWesterbergBDLeaJ, et al. Shared decision making and decisional conflict in the management of vestibular schwannoma: a prospective cohort study. J Otolaryngol Head Neck Surgery. 2018;47(1):52.
68.
HolzelLPKristonLHarterM. Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician: a structural equation model test. BMC Health Serv Res. 2013;13:231.
69.
LamWWKwokMChanM, et al. Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery?Patient Educ Couns. 2014;94(2):243–9.
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