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. 2010 May;42(5):257-63.
doi: 10.1016/j.aprim.2009.09.020. Epub 2009 Nov 28.

[Patient involvement in decision making in primary care clinics: development of a measuring tool]

[Article in Spanish]
Roger Ruiz Moral  1 , Lucía Peralta Munguia, Luis Angel Pérula de Torres, Enrique Gavilán Moral, José Ramón Loayssa Lara
Affiliations

[Patient involvement in decision making in primary care clinics: development of a measuring tool]

[Article in Spanish]
Roger Ruiz Moral et al. Aten Primaria. 2010 May.

Abstract
in English, Spanish

Objectives: This work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings.

Design: Cross-sectional, development of a measurement tool.

Setting: Primary care clinics.

Participants: Family doctors and residents.

Interventions: Based on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement.

Main measurements: The involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process.

Results: Some degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96.

Conclusions: The levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care.

Objetivos: Explorar el involucramiento de los pacientes en la toma de decisiones (IPTD) que hacen médicos de familia españoles y describir el desarrollo de un instrumento para su valoración.

Diseño: Descriptivo, desarrollo de un instrumento de medida.

Emplazamiento: Consultas de atención primaria.

Participantes: Médicos y residentes de familia.

Intervenciones: Revisión de la literatura médica sobre el tema y opiniones de médicos, selección de ítems de una escala previa utilizada para medir capacidades comunicativas genéricas (CICAA-CP), inclusión de otros específicos del proceso de participación.

Mediciones principales: El IPTD se valoró en 31 entrevistas con este primer instrumento, tras lo cual se reformuló la escala. Posteriormente se completó el proceso con un pool de 161 entrevistas. Se estimaron algunas propiedades psicométricas (fiabilidad y consistencia interna) en diferentes muestras y estadios del proceso.

Resultados: En 31 encuentros se encontró algún grado de participación del paciente. A pesar de eso, en sólo 18 de estos encuentros (58%) hubo discusión sobre más de una opción de tratamiento. Los valores κ de Cohen de la escala CICAA-Decisión estuvieron entre 0,48 y 0,94. El α de Cronbach fue de 0,60/0,51. El coeficiente de correlación intraclase global fue de 0,96.

Conclusiones: Los niveles de participación de los pacientes en las consultas de atención primaria pueden considerarse bajos. Una simple pregunta como la definida en un ítem y la escala CICAA-Decisión, en general podría ser útil para valorar el IPTD en estas consultas.

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Figures

Esquema general del estudio
Esquema general del estudio
Estudio descriptivo de validación de un instrumento de medida. Fase 1 Desarrollo del instrumento y escala. Fase 2 Muestra de pacientes y profesionales
Figura 1
Figura 1
Esquema orientativo para valorar el nivel de participación del paciente en la toma de decisiones que promueve un profesional.
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References

    1. Guadagnoli E., Ward P. Patient participation in decision-making. Soc Sci Med. 1998;47:329–339. - PubMed
    1. Kiesler D., Auerbach S. Optimal matches of patients’ preferences for information, decision-making and interpersonal behaviour: Evidence, models and interventions. Patient Educ Couns. 2006;61:319–341. - PubMed
    1. McKinstry B. Do patient wish to be involved in decision making in the consultation? A cross-sectional survey with video vignettes. BMJ. 2000;321:867–871. - PMC - PubMed
    1. Robinson A., Thomson R. Variability in patient preferences for participating in medical decision making: Implication for the use of decision support tools. Qual Health Care. 2001;10:134–138. - PMC - PubMed
    1. Swenson S., Buell S., Zettiler P., White M., Ruston D., Lo B. Patient-centred communication. Do patient really prefer it? J Gen Intern Med. 2004;19:1069–1079. - PMC - PubMed

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