Lyon 2017

9th International
Shared Decision Making conference in Lyon, France,
July 2nd - July 5th, 2017











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Other measures


Several other measures have been developed/translated and psychometrically tested over the last years. Short descriptions of these publications are given below..


If you have any questions, please send an e-mail to Levente Kriston.


Four Habits Coding Scheme – German version

The German version of the Four Habits Coding Scheme – association between physicians' communication and shared decision making skills in the medical encounter.


Scholl I, Nicolai J, Pahlke S, Kriston L, Krupat E, Härter M. (2014) Patient Education and Counseling, 94: 224-229.



Objective: To translate a measure of physicians' communication skills, the Four Habits Coding Scheme (4HCS), into German, to examine its psychometric properties, and to analyze its association with the OPTION Scale, which assesses physicians' shared decision making (SDM) behavior.


Methods: We performed a secondary data analysis of 67 audio-recorded medical consultations. Reliability, internal consistency, and factorial validity of the translated 4HCS were analyzed. The association with the OPTION Scale was examined using correlation and linear regression.


Results: Testing of reliability revealed intraclass correlation coefficients above .70. Results regarding internal consistency and factorial validity were inconclusive. The correlations between the OPTION score and the four dimensions of the 4HCS were .04 (p=.782), -.14 (p=.303), -.15 (p=.279) and .55 (p<.001), respectively. In multiple regression the four dimensions of the 4HCS explained substantial amount of variation in the OPTION scores (R(2)=.42, P<.001).


Conclusion: The measure showed good observer reliability, however further testing is necessary. Due to the strong interrelation of both measures, SDM should be seen in the context of broader communication skills.


Practice implications: The 4HCS can be used in research and medical education. Further studies are necessary that investigate SDM within the context of communication skills.



Autonomy Preference Index – German version (API-Dm)

The German modified version of the Autonomy Preference Index (API-Dm)


Simon D, Kriston L, Härter M. (2011)  Klinische Diagnostik und Evaluation, 4: 5-14.



The Autonomy-Preference-Index (API) was developed to measure patients' preferences for information and participation in medical decisions. The original English version consists of 23 items with a response format ranging from 0 ("strongly disagree") to 4 ("strongly agree"). Eight items evaluate the preference for information and 15 items measure the preference for participation. Thereof six items assess the overall participation preference and nine items relate to the participation preference in one of three clinical vignettes representing different levels of illness severity. Internal consistency is .82 for both sub scales and test-retest reliability amounts to .84 for the preference for participation and .83 for the preference for information. A German translation of the API without vignettes was used in the research consortium "The patient as partner in medical decision making". Construct validity was tested using a confirmatory factor analysis on a comprehensive sample of n = 1592 patients. Based on several fit indices two items measuring the preference for participation and one item assessing the preference for information were deleted. The German modified Version (API-Dm) resulted in improved scores. Yet, due to limitations of this study further psychometric tests are recommended. 



Decisional Conflict Scale – German version (DCS-D)

German-language version of Decisional Conflict Scale (DCS-D). Dimensional structure in a sample of family physician patients.


Buchholz A, Hölzel L, Kriston L, Simon D, Härter M (2011). Klinische Diagnostik und Evaluation, 4: 15-30.



The Decisional Conflict Scale (DCS) has been developed as an outcome assessment for the evaluation of decision-support systems. It captures uncertainty about which course of action to take facing a medical decision. While the DCS has been widely used, studies investigating its psychometric properties are scarce. There is no published data on the German DCS available. Aim of this study was to investigate psychometric properties of a German version of the DCS. For this study, data have been gathered in a large postal survey investigating the effects of integrated primary health care. Data of 1286 respondents were included in the analyses. Confirmatory factor analyses revealed the five-dimensional structure as suggested by the original authors as superior to other investigated factorial structures. Furthermore, the internal consistency of the five subscales was found to be high. This study corroborates the factorial validity and reliability of the German DCS.


Preparation for Decision-Making Scale – German version (PDMS-D)

The Preparation for Decision-Making Scale in the German language (PDMS-D) – Factorial and concurrent validity in an online sample of persons with lower back pain or depression.


Buchholz A, Simon D und Härter M (2011). Klinische Diagnostik und Evaluation 4 Jg. 31–45.



Aim of this study was to investigate the dimensional structure, concurrent validity, and reliability of German Preparation for Decision-Making Scale (PDMS-G). Data were gathered as part of an online RCT evaluating a web-based interactive decision aid by health insurants suffering from low-back pain and/or depression. A total of 572 participants were included in the analysis. Confirmatory factor analyses (CFA) revealed a two-dimensional structure. Correlations with related constructs (decisional conflict, knowledge, acceptability) were found significant and minor to high, whereas age, gender and health-related quality of life were not associated with PDMS-G. Our results corroborate concurrent validity and reliability of the PDMS-G, whereas the CFA does not support prior findings regarding dimensionality and should be subject of future research: Instead of one we found two dimensions, preparation for the medical encounter and preparation for decision making. The use of the PDMS-G can be recommended for the evaluation of decision aids.




Questionnaire on satisfaction in outpatient care – Focus on patient participation (ZAPA)


Scholl I, Hölzel L, Härter M, Dierks ML, Bitzer EM, Kriston K.(2011). Klinische Diagnostik und Evaluation 4Jg. 50–62.



The goal of this study was to develop and psychometrically evaluate a short questionnaire (four items) for measuring patient satisfaction in outpatient medical care under consideration of the concept of patient participation. To this aim, two items of an existing instrument were used (Questionnaire on Satisfaction in Outpatient Care – Quality from the patients’ perspective – ZAP), and two new items were generated. With the new instrument (ZAPA), data were gathered from a sample of 2450 patients. The dimensional structure was determined by means of factor analysis. In addition, reliability measures as well as descriptive item parameters were calculated. Moreover, construct validity was checked. The ZAPA shows a one-dimensional structure. A high internal consistency as well as high discriminatory powers point to a high reliability of the questionnaire. Completion rates of over 94% demonstrate a good acceptance of the instrument. Furthermore, there are indications of construct validity. On the whole, the ZAPA shows good psychometric properties. Due to its brevity, it is suitable for use in studies to measure patient satisfaction in outpatient care settings.



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Update: 26. Jan. 2017