Measuring decision quality: where we stand today

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This paper defines ‘decision quality’ as the extent to which treatments reflect the considered preferences of well-informed patients and are implemented.  It sets out the four main elements involved in the decision-making process to ensure a high quality decision, and how these can be measured. It includes a fully-worked example of how to measure the quality of decision making for knee osteoarthritis, which can provide a template for developing materials for other conditions. 

Decision quality is defined as combining knowledge, patients’ goals, concerns and preferences, and patient engagement in the decision making process.  The paper sets out findings from the literature on medical decision making that there are four main elements of a good process:

  • the patient is told about the reasonable options,
  • the patient and provider discuss the pros of those options,
  • the patient and provider discuss the cons of those options,
  • the provider and patient discuss patients’ goals and preferences related to the options and outcomes

The paper explores different approaches to measuring patient knowledge and measuring the extent to which decisions are in accordance with patient goals and values.

The example materials to measure decision quality for knee osteoarthritis include a series of brief patient surveys on:

  • what was most important to the patient in making a decision about whether or not to have surgery
  • how much the patient knows about facts related to the surgery
  • what happened when the patient talked with their health provider about their options
  • their treatment choice

It includes supporting information to enable the surveys to be used and analysed.

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