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The development and initial validation of an observational tool for measuring patient participation in clinical consultations
Abstract
Objective: The aim of this study was to further develop and test The Activity Barometer (TAB) as a tool for measuring patient participation in clinical consultations.
Methods: The tool was further developed and tested by double coding 18 audio recordings from consultations between nurses and patients and by qualitative discussions between 3 raters. The raters discussed the face and content validity of the tool and the inter-rater reliability was calculated. To assess the construct validity, it was hypothesised that the tool could be used to expose a difference in the patients’ participation before and after the nurses had participated in communication skills training. This was assessed based on 31 audio recordings.
Results: All of the 3 raters found the items relevant for measuring patient participation. However, to get reliable ratings, an extended guide for coding was necessary. According to the content validity, we found that by taking a treatment-oriented perspective, core components of patient participation were not included in the tool. To capture the whole concept, the coding should be done from a holistic perspective, including the patients’ everyday life. The inter-rater reliability for the total score (0.85), the questions (0.92) and the preferences/concerns (0.6) were all above acceptable thresholds. The construct validation showed that the tool could expose differences in the patients’ participation before and after the nurses had participated in the communication skills training.
Conclusion: TAB is a promising tool for measuring patient participation. However, further validation of the tool in a larger sample is recommended prior to its use in research settings.
Keywords
References
Street, R.L., Gordon, H.S., Ward, M.M., Krupat, E. & Kravitz, R.L. (2005). Patient participation in medical consultations: why some patients are more involved than others. Medical Care 43 (10) 960-969.
Phillips, N.M., Street, M. & Haesler, E. (2016). A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. BMJ Quality & Safety 25 (2) 110-117.
Melbourne, E., Sinclair, K., Durand, M., Légaré, F. & Elwyn, G. (2010). Developing a Dyadic OPTION scale to measure perceptions of shared decision making. Patient Education and Counseling 78 (2) 177-183.
Scholl, I., Loon, M.K., Sepucha, K., Elwyn, G., Légaré, F., Härter, M. & Dirmaier, J. (2011). Measurement of shared decision making - a review of instruments. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 105 (4) 313-324.
Ilan, S. & Carmel, S. (2016). Patient communication pattern scale: psychometric characteristics. Health Expectations 19 (4) 842-853.
Eldh, A.C., Luhr K., & Ehnfors M. (2015). The development and initial validation of a clinical tool for patients' preferences on patient participation - The 4Ps. Health Expectations 18 (6) 2522-2535.
Sheridan, S.L., Harris, R.P. & Woolf, S.H. (2004). Shared decision making about screening and chemoprevention; a suggested approach from the U.S. Preventive Services Task Force. American Journal of Preventive Medicine 26 (1) 56-66.
Kasper, J., Hoffmann, F., Heesen, C., Köpke, S. & Geiger, F. (2012). MAPPIN'SDM - The Multifocal Approach to Sharing in Shared Decision Making. PLoS One 7 (4) 1-9.
Pedersen, V.H., Schrøder, D., Wandel A. & Freil M. (2014). Reporting of a pilot project to develop and test an instrument to measure patient participation in medical consultations. Danish Knowledge Center of User Involvement in Healthcare (ViBIS).
ViBIS. (2016). The Activity Barometer - a tool to measure patients' participation i clinical consultations. Available at:
http://vibis.dk/aktivitetsbarometret-et-redskab-til-maale-patienters-deltagelse-i-konsultationer (last accessed 10 May 2016).
Masahito, J., Elwyn, G., Kelly-Blake, K., Hawley, S., Rapai, M., Sen, A. & Ruffin, M. (2013). Observer OPTION Patient: Development of a new tool to evaluate shared decision making. Poster presented at conference on patient involvement in Copenhagen Nov 5th.
Coulter, A. (2011). Engaging patients in healthcare. Milton Keynes: Open University Press.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 84 (2) 191-215.
Maguire, P., Booth, K., Elliott, C. & Jones, B. (1996). Helping health professionals involved in cancer care acquire key interviewing skills - the impact of workshops. European Journal of Cancer 32A (9) 1486-1489.
Silverman, J.D., Kurtz, S.M. & Draper, J. (1998). Skills for communicating with patients. Oxon: Radcliffe Medical Press Ltd.
Ammentorp, J. & Kofoed, P.E. (2011). Research in communication skills training translated into practice in a large organization: a proactive use of the RE-AIM framework. Patient Education and Counseling 82 (3) 482-487.
Coulter, A. & Ellins, J. (2006). Patient-focused interventions: A review of the evidence. London: The Health Foundation.
Kirkwood, B.R. & Sterne, J.A.C. (2003). Essential medical statistics. Malden, MA: Blackwell Pubublishing.
Sullivan, G.M. & Feinn, R. (2012). Using Effect Size - or Why the P Value Is Not Enough. Journal of Graduate Medical Education 4 (3) 279-282.
Vermeire, E., Hearnshaw, H., Van Royen, P. & Denekens, J. (2001). Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics 26 (5) 331-342.
Dwamena, F., Holmes-Rovner, M, Gaulden, C.M., Jorgenson, S., Sadigh, G., Sikorskii, A., Lewin, S., Smith, R.C., Coffey, J. & Olomu, A. (2012). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 12, CD003267.
Légaré, F., Turcotte, S., Stacey, D., Ratté, S., Kryworuchko, J. & Graham, I.D. (2012). Patients’ perceptions of sharing in decisions: A systematic review of interventions to enhance shared decision making in routine clinical practice. The Patient: Patient-Centered Outcomes Research 5 (1) 1-19.
DOI: http://dx.doi.org/10.5750/ejpch.v5i1.1224
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