Patient involvement and person-centered medicine in cardiovascular prevention: Modelling the items of the OPTION instrument on process steps of shared decision-making

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Heidemarie Keller
Oliver Hirsch
Meike Müller-Engelmann
Monika Heinzel-Gutenbrunner
Norbert Donner-Banzhoff
Tanja Krones


Rationale, aims and objectives: In cardiovascular prevention within primary care, there is a lack of empirical information about how patients are involved in decision-making processes. Our research aim in the present study was to model the delineated items of the OPTION instrument on theoretical shared decision-making process steps in order to investigate how physicians’ competences correspond to the defined process steps as reported in the literature. Method:  We tested the adequacy of a theoretical model which links certain items of the original OPTION instrument to specific steps of the shared decision making process and validated our model by the inclusion of the expert consensus ratings where different shared decision-making steps took place.Design: Cross-sectional assessment of physician-patient interaction by two rater pairs using a cross-over design and additional rating of two experts in shared decision making (SDM). The study sample consisted of 15 general practitioners who provided 40 videotaped consultations.Results: We found support for our theoretical model when linking items of the OPTION instrument to steps of the shared decision-making process. The validation of our model using expert consensus ratings resulted in only a partial support for our model.Conclusions: Our research provides insight into some of the dilemmas in measuring shared decision-making. On the one hand, these measures provide evidence as to which key elements of shared decision-making are likely to be presented in a consultation and those which may be more problematic in practice. Equally, it may be that we need to recognise the limitations of measurement and its ability to capture the full complexity of the shared decision-making process.

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Author Biographies

Heidemarie Keller, Department of General Practice, Philipps University of Marburg, Germany

Senior Lecturer & Research Fellow, Department of General Practice, Philipps University of Marburg, Germany

Norbert Donner-Banzhoff, Philipps University of Marburg, Germany

Professor and Head of Department of General Practice

Tanja Krones, University Hospital Zurich & Institute of Biomedical Ethics, University of Zurich, Switzerland; Department of General Practice, Philipps University of Marburg, Germany

Professor and Head of Clinical Ethics


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