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

Abstract

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.