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Psychometric Evaluation of a Decision Quality Instrument for Treatment of Lumbar Herniated Disc

Sepucha, Karen R., PhD*; Feibelmann, Sandra, MPH; Abdu, William A., MD, MS; Clay, Catharine F., MA, RN§; Cosenza, Carol, MSW; Kearing, Stephen, MS§; Levin, Carrie A., PhD[BULLET OPERATOR]; Atlas, Steven J., MD, MPH*

doi: 10.1097/BRS.0b013e3182532924
Health Services Research

Study Design. Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file.

Objective. To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc.

Summary of Background Data. There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality.

Methods. The herniated disc–decision quality instrument (HD-DQI) was developed with input from clinical experts, survey research experts, and patients. The HD-DQI produces 2 scores each scaled to 0% to 100%, with higher scores indicating better quality: (1) a total knowledge score and (2) a concordance score (indicating the percentage of patients who received treatments that matched their goals). We examined hypotheses relating to the acceptability, feasibility, validity, and reliability of the instrument, using data from 3 samples.

Results. The HD-DQI survey was feasible to implement and acceptable to patients, with good response rates and low missing data. The knowledge score discriminated between patients who had seen a decision aid or no decision aid (55% vs. 38%, P < 0.001) and between providers and patients (73% vs. 46%, P < 0.001). The knowledge score also had good retest reliability (intraclass correlation coefficient = 0.85). Most patients (78%) received treatments that matched their goals. Patients who received treatments that matched their goals were less likely to regret the decision than those who did not (13% vs. 39%, P = 0.004).

Conclusion. The HD-DQI met several criteria for high-quality patient-reported survey instruments. It can be used to determine the quality of decisions for treatment of herniated disc. More work is needed to examine acceptability for use as part of routine patient care.

Given the increasing importance of engaging patients and families in significant medical decisions, there is a need for measures to assess the quality of these decisions. This article evaluates the psychometric properties of the herniated disc–decision quality instrument (HD-DQI) using 3 different samples. The HD-DQI meets many criteria for high-quality patient-reported surveys and can be used to determine whether patients have made informed decisions that match their goals.

*General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA

General Medicine Division, Massachusetts General Hospital, Boston, MA

Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH

§The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH

Center for Survey Research, University of Massachusetts, Boston, MA

[BULLET OPERATOR]Informed Medical Decisions Foundation, Boston, MA

Address correspondence and reprint requests to Karen R. Sepucha, PhD, Health Decision Sciences Center, Massachusetts General Hospital, 50 Staniford St., 9th floor, Boston, MA 02114; E-mail:

Acknowledgment date: November 30, 2011. Revision date: February 22, 2012. Acceptance date: February 27, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation/professional organizational funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.