Article Figures & Data
Tables
Characteristic Mean No. SD Percent Age, years 45 8.2 Sex Female 23 23.0 Male 77 77.0 Family practitioner Yes 47 47.0 No 53 53.0 Solo practitioner Yes 24 24.0 No 76 76.0 Rural practice Yes 32 32.0 No 68 68.0 Total 100 100.00 Characteristic Number Percent Sex Female 2,955 62.3 Male 1,750 36.9 Missing 41 0.9 Patient race/ethnicity African American 499 10.5 Hispanic 109 2.3 Other 110 2.3 White 3,994 84.2 Missing 34 0.7 Length of patient-physician relationship <1 year 360 7.6 1–3 years 1,035 21.8 3–5 years 814 17.2 >5 years 2,525 53.2 Missing 12 0.3 Patient education <12 years 337 7.1 12th grade 1,370 28.9 1–3 years college 1,490 31.4 4 years college 828 17.4 Graduate school 700 14.7 Missing 21 0.4 Items Score * Indicates modified Braddock items. 1 Explain the clinical issue or nature of the decision* 0 No evidence ______ ½ Physician gives a cursory, hurried, unclear, rushed explanation, or long confusing lecture 1 Physician clearly explains his/her view of the medical/clinical problem 2 Discussion of the uncertainties associated with the situation* 0 No evidence ______ ½ Physician acknowledges uncertainties but does not explain thorough or only does with active patient prompting 1 Physician thoroughly explains uncertainties in the problem or treatment 3 Clarification of agreement 0 No evidence ______ ½ Patient expressed passive assent 1 Physician actively asks for patient agreement and tries to obtain a commitment from the patient to the treatment plan 4 Examine barriers to follow-through with treatment plan 0 No evidence ______ ½ Patient discloses concerns or problems with following through with treatment 1 Physician actively examines patients concerns or problems with following through with treatment 5 Physician gives patient opportunity to ask questions and checks patients understanding of the treatment plan* 0 No opportunity for patient to ask questions ______ ½ Patient has opportunity to ask questions 1 Physician asks patients for their understanding of problem or plans 6 Physician’s medical language matches patient’s level of understanding −½ Clear mismatch between the technicality of physician’s and patient’s language ______ ½ Level of technicality or detail of the physician’s and patient’s language matches most of the time. 1 Level of technicality or detail of the physician’s and patient’s language clearly matches. 7 Physician asks, “Any questions?” 0 No evidence ______ ½ Yes, but no discussion ensues 1 Yes. and physician engages in a discussion with patient about the questions 8 Physician asks open-ended questions. 0 No evidence ______ ½ Yes. but no discussion ensues 1 Yes.and physician engages in a discussion with patient about the question 9 Physician checks his/her understanding of patient’s point of view* 0 No evidence ______ ½ Yes, but no discussion ensues 1 Yes, and physician engages in a discussion with patient about the physician’s perceptions of patients Sum ______ Discarded items Discussion of the patient’s role in decision making* 0 No evidence ½ Yes, but no discussion ensues 1 Yes, and physician engages in a discussion with patient about the patient’s role Discussion of the alternatives* 0 No evidence ½ Yes, but no discussion ensues 1 Yes, and physician engages in a discussion with patient about the alternative treatments available Discussion of the pros (potential benefits) and cons (risks) of the alternatives* 0 No evidence ½ Yes, but no discussion ensues 1 Yes, and physician engages in a discussion with patient about the pros and cons of the alternative treatments Frequency and Percentage* Item Mean† SD 0 ¼ ½ ¾ 1 * In this table, the frequency is per 100 cases, so percentage is equal to frequency. † Items for the RPAD were scored 0, ½, and 1, averaged over 2 cases. 1. Explain the clinical issue 0.89 0.18 0 1 11 19 69 2. Discuss uncertainties 0.20 0.25 53 22 19 5 1 3. Clarify agreement 0.57 0.14 0 2 72 23 3 4. Examine barriers 0.02 0.09 93 5 2 0 0 5. Patients asked questions 0.49 0.11 2 6 89 2 1 6. Physician’s medical language 0.55 0.15 3 0 75 20 2 7. Physician asks, Any questions? 0.25 0.29 46 27 12 12 3 8. Physician asks open-ended questions 0.07 0.18 84 7 6 3 0 9. Physician checks understanding 0.10 0.21 77 10 9 3 1 Patient Self-Report RPAD Total RPAD = Rochester Participatory Decision-Making Scale; MD-SP = physician-standardized patient; MPCC = Measure of Patient-Centered Communication; C1, C2, C3 = Components 1, 2, 3. * P ≤.005. † P ≤.01. Coding of audiotapes (n = 193) Total MPCC score 0.24* C1 - Exploring the Disease and Illness 0.18† C2 - Whole Person 0.08 C3 - Diagnosis and Treatment 0.19† Physician characteristics (n = 193) Age 0.06 Female 0.07 Years in practice 0.02 Solo practice −0.02 Number of partners 0.14 SP survey (n = 193) Health care climate 0.36* Trust in physician 0.32* Patient survey (n = 4,746) Health care climate 0.07* Knowledge of patient 0.06* Trust in physician 0.06* Patient satisfaction 0.06*
Additional Files
Supplemental Appendix and Tables
Supplemental Appendix. Statistical Analysis Multilevel Modeling; Supplemental Table 1. Characteristics of Patients In Sample; Supplemental Table 2. Regressions of Patient Surveys on RPAD and MPCC Components; Supplemental Table 3. Regressions of Standardized Patient Surveys on RPAD and MPCC Components.
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 2 pages, 75KB
- Supplemental data: Tables 1-3 - PDF file, 3 pages, 165KB
The Article in Brief
Rochester Participatory Decision-Making Scale (RPAD): Reliability and Validity
By Cleveland G. Shields, PhD, and colleagues
Background: Doctors have been encouraged to adopt a more participatory style, in which patients are directly involved in decisions about their medical treatment. Measuring participatory decision-making in research has been difficult. The purpose of this study was to develop a reliable and valid way to measure the doctors� behavior in encouraging participatory decision-making.
What this study found : The Rochester Participatory Decision-Making Scale (RPAD) was developed, based on data from a study of doctor-patient communication involving 100 primary care doctors. RPAD assesses the ways in which doctors encourage patients to participate in decision-making.
Implications
� RPAD offers promise as a reliable, valid, and easy-to-use measure of participatory decision-making.
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