Background
Methods
Design
Setting
Sample
Measures
Procedures
Stage 1 (Development of source language CDIS)
Measure | Content validity | Construct validity | Floor/Ceiling effect | Internal consistency | Reliability | Brevity | Simplicity | Relevance |
---|---|---|---|---|---|---|---|---|
Measures of involvement only
| ||||||||
Patients Preference for Control [41] | Unknown | Unknown | Unknown | Unknown | Unknown | Adequate | Adequate | Adequate |
Control Preferences Scale [42] | Unknown | Adequate | Unknown | Unknown | Adequate | Adequate | Adequate | Adequate |
Facilitation of Patient Involvement [43] | Unknown | Adequate | Unknown | Adequate | Adequate | Adequate | Adequate | Doubtful |
Desire to Participate in Medical Decision Making Scale [44] | Adequate | Doubtful | Unknown | Adequate | Adequate | Adequate | Adequate | Doubtful |
Decision Self-Efficacy Scale [45] | Unknown | Adequate | Unknown | Adequate | Adequate | Adequate | Adequate | Poor |
Measures of satisfaction only
| ||||||||
Satisfaction with Decision Scale [46] | Unknown | Adequate | Unknown | Adequate | Adequate | Adequate | Adequate | Adequate |
Measures of involvement and satisfaction
| ||||||||
Decisional Conflict Scale [47] | Unknown | Adequate | Unknown | Adequate | Adequate | Adequate | Adequate | Poor |
Autonomy Preference Index [48] | Adequate | Adequate | Poor | Adequate | Adequate | Poor | Doubtful | Doubtful |
Stage 2 (Development of target language CDIS)
ISPOR Stages 1 to 3: forward translation and reconciliation
ISPOR stages 4 to 5: back translation
ISPOR stages 6 to 10: harmonisation and review
Stage 3 (Psychometric evaluation)
Analysis
Results
Stage 1 (Development of source language CDIS)
Wording in CDIS-S | Wording in CDIS-P | |
---|---|---|
Involvement sub-scale (one item) |
Score
| |
The service user made the final decision | I made the final decision. | Active |
The service user made the final decision after seriously considering my opinion | I made the final decision after seriously considering my clinicians opinion | Active |
The service user and I shared responsibility for making the best decision for them | My clinician and I shared responsibility for making the best decision for me | Shared |
I made the final decision, after seriously considered the service user’s opinion | My clinician made the final decision, but seriously considered my opinion | Passive |
I made the final decision | My clinician made the final decision | Passive |
Satisfaction sub-scale (six items) |
Rating scale
| |
1. I had adequate information from the service user about the issues important to them | 1. I am satisfied that I am adequately informed about the issues important to the decision | 5-point Likert scale from 1 (Strongly disagree) to 5 (Strongly agree) |
2. The decision we made was the best decision possible in my view | 2. The decision we made was the best decision possible in my view | |
3. I am satisfied that the decision was consistent with my personal and professional values | 3. I am satisfied that the decision was consistent with my personal values | |
4. I expect the decision we made to be successfully acted on/continued to be acted on | 4. I expect the decision we made to be successfully acted on/continued to be acted on | |
5. I am satisfied that this was the decision to make | 5. I am satisfied that this was the decision to make | |
6. I am satisfied with the decision | 6. I am satisfied with the decision |
Stage 2 (Development of target language CDIS)
Stage 3 (Psychometric evaluation)
Ulm | London | Naples | Aalborg | Debrecen | Zurich | Total | |
---|---|---|---|---|---|---|---|
n
| 91 | 43 | 86 | 70 | 95 | 58 | 443 |
Male (%) | 29 (32) | 32 (74.4) | 46 (53.5) | 31 (44.3) | 49 (51.6) | 18 (31) | 205 (53.7) |
Age in years (s.d.) | 45.6 (9.1) | 45.2 (10.6) | 43 (10.5) | 39.8 (10.7) | 45.2 (10) | 40.4 (10.6) | 42.5 (10.4) |
Years in education (s.d.) | 10.6 (1.7) | 11.2 (1.9) | 11.2 (1.9) | 9.7 (1.1) | 11.3 (1.3) | 9.7 (1.4) | 10.5 (1.9) |
Marital status (%) | |||||||
Unmarried
| 32 (35) | 37 (86) | 39 (45) | 41 (59) | 43 (45) | 28 (48) | 220 (50) |
Married/co-habiting
| 29 (32) | 2 (4.2) | 32 (37) | 12 (17) | 32 (34) | 15 (26) | 122 (28) |
Separated/divorced/widowed
| 30 (33) | 4 (9.4) | 15 (17) | 16 (23) | 20 (21) | 15 (26) | 100 (23) |
Living situation (%) | |||||||
Alone
| 50 (55) | 13 (30.2) | 13 (15) | 40 (57) | 21 (22) | 36 (63) | 173 (39) |
With spouse/partner
| 31 (34) | 2 (4.7) | 35 (40) | 18 (26) | 34 (36) | 16 (28) | 136 (31) |
With others
| 10 (11) | 28 (65.1) | 37 (43) | 12 (17) | 40 (42) | 5 (9) | 132 (30) |
Employment (%) | |||||||
Paid/student
| 24 (26) | 4 (9.3) | 27 (31) | 4 (6) | 18 (19) | 21 (36) | 100 (23) |
Sheltered employment
| 5 (6) | 0 | 1 (1) | 1 (1) | 3 (3) | 1 (2) | 11 (2) |
None
| 60 (67) | 37 (86) | 56 (65) | 65 (92) | 73 (76) | 36 (63) | 327 (74) |
Main income (%) | |||||||
Salary
| 20 (22) | 0 | 27 (31) | 3 (4) | 18 (19) | 13 (23) | 81 (19) |
Benefits
| 20 (22) | 34 (79.1) | 27 (31) | 20 (29) | 7 (7) | 3 (5) | 103 (24) |
Pension
| 40 (44) | 0 | 2 (2) | 45 (64) | 67 (71) | 35 (63) | 189 (44) |
Family support
| 11 (12) | 2 (4.7) | 38 (44) | 0 | 1 (1) | 5 (9) | 57 (13) |
Years since first contact with mental health services (s.d.) | 14.1 (9.1) | 13.1 (9.1) | 12.7 (10.04) | 12 (8) | 13.6 (7.5) | 8.7 (8.3) | 12.5 (8.9) |
DSM-IVR Research diagnosis | |||||||
Schizophrenia and other psychotic disorders
| 32 (35) | 25 (58.2) | 23 (27) | 45 (64) | 54 (56) | 15 (26) | 194 (44) |
Mood disorders
| 41 (45) | 5 (11.6) | 33 (38) | 17 (24) | 20 (21) | 27 (47) | 143 (32) |
Other
| 18 (20) | 7 (16.3) | 30 (35) | 8 (11) | 21(22) | 16 (28) | 98 (22) |
Mental health in-patient admissions in previous year (%) | 44 (48) | 11 (25.6) | 0 | 15 (21) | 23 (24) | 25 (43) | 118 (27) |
Service user-rated outcomes
| |||||||
STORI (%) | |||||||
Moratorium
| 16 (18) | 7 (16) | 20 (23) | 13 (19) | 16 (17) | 13 (22) | 85 (19) |
Awakening/Preparation
| 16 (18) | 13 (30) | 35 (21) | 7 (10) | 11 (12) | 15 (26) | 97 (22) |
Rebuilding/Growth
| 58 (64) | 23 (54) | 31 (36) | 50 (71) | 68 (72) | 30 (52) | 260 (59) |
MANSA (mean, s.d.) | 4.4 (1.0) | 4.2 (0.8) | 3.43 (0.8) | 4.6 (1) | 4.5 (0.8) | 3.6 (1.2) | 4.1 (1.0) |
OQ-45 (mean, s.d.) | 77.4 (28.2) | 66.1 (2.6) | 77.2 (22.7) | 69.7 (24.7) | 61.4 (23) | 81.2 (26.7) | 72.2 (25.9) |
HAS-P (mean, s.d.) | 7.1 (1.3) | 6.8 (2.4) | 7.3 (1) | 7.2 (1.3) | 7.7 (0.7) | 8.1 (1.3) | 7.2 (1.3) |
Staff-rated outcomes
| |||||||
TAG (mean, s.d.) | 8.2 (2.3) | 8.9 (2.2) | 7.6 (2.4) | 7.4 (2.2) | 6.3 (1.6) | 6.7 (1.8) | 7.4 (2.2) |
HAS-S (mean, s.d.) | 7.6 (1.0) | 8.1 (1.0) | 8.1 (1.7) | 8.1 (1.2) | 7.9 (1.1) | 8.2 (0.8) | 8.0 (102) |
Stability
Ulm | London | Naples | Aalborg | Debrecen | Zurich | Total | |
---|---|---|---|---|---|---|---|
CDIS SERVICE USER
n
|
91
|
43
|
86
|
70
|
95
|
58
|
443
|
Satisfaction mean (s.d.) | 4.11 (0.70) | 4.21 (0.92) | 4.25 (0.71) | 4.45 (0.53) | 4.45 (0.56) | 3.75 (0.58) | 4.23 (0.69) |
Involvement n (%) | |||||||
Passive involvement | 28 (31) | 8 (19) | 25 (29) | 16 (23) | 27 (28) | 14 (24) | 118 (26.6) |
Shared involvement | 36 (40) | 13 (30) | 50 (58) | 33 (47) | 57 (60) | 30 (52) | 219 (49.4) |
Active involvement | 27 (30) | 22 (51) | 11 (13) | 21 (30) | 11 (12) | 14 (24) | 106 (23.9) |
CDIS STAFF
n
|
80
|
23
|
86
|
67
|
95
|
54
|
405
|
Satisfaction mean (s.d.) | 3.94 (0.53) | 4.24 (0.54) | 4.32 (0.58) | 4.09 (0.65) | 4.22 (0.61) | 4.02 (0.42) | 4.14 (0.58) |
Involvement n (%) | |||||||
Passive involvement | 13 (16) | 1 (4) | 55 (64) | 8 (12) | 9 (9) | 8 (15) | 94 (23.3) |
Shared involvement | 32 (40) | 9 (39) | 27 (31) | 23 (34) | 64 (67) | 32 (59) | 187 (46.3) |
Active involvement | 34 (43) | 13 (57) | 4 (5) | 36 (54) | 22 (23) | 14 (26) | 123 (30.4) |
Construct validity
Convergent validity | Divergent validity | ||||||
---|---|---|---|---|---|---|---|
GAF | MANSA | HAS-S | HAS-P | OQ-45 symptom distress | OQ-45 symptom distress | HoNOS | |
Staff
| |||||||
CDIS Involvement |
-0.20
|
-0.19
| 0.08 | 0.001 | |||
p < 0.001
|
p < 0.001
|
p = 0.10
|
p = 0.98
| ||||
CDIS Satisfaction |
0.46
|
0.33
|
-0.15
| -0.08 | |||
p < 0.001
|
p < 0.001
|
p = 0.002
|
p = 0.13
| ||||
CDIS Satisfaction (Utility) |
0.38
|
0.30
|
-0.13
|
-0.11
| |||
p < 0.001
| p < 0.001 |
p = 0.009
|
p = 0.03
| ||||
Service user
| |||||||
CDIS Involvement | -0.05 | 0.02 | 0.05 | -0.008 | |||
p = 0.32
|
p = 0.70
|
p = 0.32
|
p = 0.87
| ||||
CDIS Satisfaction |
0.22
|
0.42
|
-0.24
| -0.02 | |||
p < 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.87
| ||||
CDIS Satisfaction (Utility) |
0.19
|
0.36
|
-0.19
| -0.02 | |||
p < 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.72
|
Convergent validity | Divergent validity | ||||||
---|---|---|---|---|---|---|---|
GAF | MANSA | HAS-S | HAS-P | OQ-45 symptom distress | OQ-45 symptom distress | HoNOS | |
Staff
| |||||||
CDIS Involvement |
0.98
| 0.78 | 1.01 | 1.01 | |||
p = 0.048
|
p = 0.085
|
p = 0.238
|
p = 0.817
| ||||
CDIS Satisfaction |
0.18
|
0.08
|
-0.006
| -0.003 | |||
p < 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.450
| ||||
CDIS Satisfaction (Utility) |
1.95
|
1.43
|
0.98
| 0.97 | |||
p < 0.001
|
p < 0.001
|
p = 0.006
| p = 0.115 | ||||
Service user
| |||||||
CDIS Involvement | 0.99 | 0.98 | 1.01 | -0.008 | |||
p = 0.34
|
p = 0.84
|
p = 0.137
|
p = 0.87
| ||||
CDIS Satisfaction |
0.11
|
0.15
|
-0.008
| -0.008 | |||
p = 0.001
|
p < 0.001
|
p < 0.001
|
p = 0.276
| ||||
CDIS Satisfaction (Utility) |
1.35
|
1.59
|
0.98
| 0.98 | |||
p = 0.004
|
p < 0.001
|
p < 0.001
|
p = 0.248
|
Predictive validity
OR (95%CI) | SE | P value | |
---|---|---|---|
SERVICE USERS
| |||
Involvement
| |||
Shared vs. Active | 1.54 (0.82-2,89) | 0.50 | 0.181 |
Passive vs. Active | 1.92 (0.94-3.94) | 0.70 | 0.075 |
Satisfaction
|
2.21 (1.51-3.23)
| 0.43 | <0.001 |
Satisfaction (Utility)
| |||
Moderate vs. Low | 1.40 (0.50-3.91) | 0.73 | 0.518 |
High vs. Low |
3.13 (1.10-8.94)
| 1.68 | 0.033 |
STAFF
| |||
Involvement
| |||
Shared vs. Active |
2.43 (1.31-4.50)
| 0.76 | 0.005 |
Passive vs. Active |
3.55 (1.53-8.24)
| 1.52 | 0.003 |
Satisfaction
|
2.43 (1.54-3.83)
| 0.57 | <0.001 |
Satisfaction (Utility)
| |||
Moderate vs. Low |
3.33 (1.11-9.97)
| 1.86 | 0.031 |
High vs. Low |
5.77 (1.90-17.53)
| 3.27 | 0.002 |