Patient and observer ratings of physician shared decision making behaviors in breast cancer consultations

Objective

Explore the validity of using patient reports to measure shared decision making (SDM).

Methods

178 patients diagnosed with breast cancer obtained SDM assistance in a university-based clinic. Trained observers rated physician SDM behaviors and surveyed patients. We calculated the frequency with which patients and observers reported maximum SDM behaviors for each survey item. We also calculated agreement frequency between patients and observers.

Results

Over 90% of patients rated doctors as reflecting SDM competencies. Patients reported doctors making recommendations more than soliciting their preferred choice (90% vs. 69%, p < 0.001). Patients heard benefits discussed “a lot” more often than they heard risks and side effects discussed “a lot” (81% vs. 58%, p < 0.001). Agreement between patients and observers was 75%. In cases of disagreement, patients more frequently perceived SDM behaviors than did observers (15% vs. 9%, p = 0.002), suggesting a possible agreement bias.

Conclusions

High agreement supports further investigation into using patients as efficient and effective raters of SDM. Patient ratings may be inflated by agreement bias.

Practice implications

Doctors presentations may be biased toward discussing benefits more than risks. Policy makers can solicit patient ratings of SDM as long as they are aware of possibly inflated ratings due to agreement bias.