Article Title

Evaluating Shared Decision-Making Across Clinical Topics in Primary Care: An Exploratory Study Using the OPTION5 Observer Measure

Publication Date



shared decision-making, evaluation


Background/Aims: Shared decision-making (SDM) is vital in primary care because it is the most common setting for patients to seek medical care and is typically the first point of contact with health services. The recently developed OPTION5 observer measure evaluates SDM during visits but has only been previously used to evaluate one topic per visit. In this study, we apply OPTION5 to analyze the extent of SDM across the spectrum of topics presented in primary care visits. OPTION5 allows observers to assess the following five items: how physicians 1) present options, 2) establish a partnership with the patient, 3) describe pros and cons of options, 4) elicit patient preferences, and 5) integrate patient preferences into the decision.

Methods: OPTION5 was used to evaluate SDM at four primary care clinics that are part of a large multispecialty group practice in northern California. Two researchers jointly identified “topics” requiring decisions, scored each item and then averaged across raters to create overall scores to indicate the level of SDM occurring for each topic. We used descriptive statistics and linear regression with cluster-robust standard errors to analyze the OPTION5 items in 40 audio-recorded visits. The models controlled for clinics and patient background characteristics.

Results: The 40 visits included 200 distinct topics (mean topics per visit was 5.03, min: 1, max: 13, SD: 2.62). The mean overall OPTION5 score was 27.2 (on a scale of 0–100), and scores ranged from a minimum of 2.5 to a maximum score of 75 (SD: 15.15). Lower patient education levels were significantly associated with lower OPTION5 scores across all five items (item 1 coefficient: -0.91, P < 0.05; item 2 coefficient: -1.68, P < 0.01; item 3 coefficient: -2.04, P < 0.01; item 4 coefficient: -1.49, P < 0.01; item 5 coefficient: -1.36, P < 0.01) and with the overall score (coefficient: -7.48, P < 0.001).

Conclusion: The relatively low overall scores suggest much room for improvement in SDM in primary care visits. The consistent association between patient education and SDM in visits suggests it is imperative to find methods to better engage patients with less education and that these patients should be a priority vulnerable population for SDM support and engagement strategies.