• This case study was provided by Cardiff and Vale University Health Board.
  • The project was carried out by the breast care team in Cardiff.
  • The team set out to measure patient involvement in shared decision making in breast care.
  • The team used two tools, a shared decision making questionnaire and a decision quality measure.

Measuring patient involvement in shared decision making can be challenging. In Cardiff, the breast care team used two tools, a shared decision making questionnaire and a decision quality measure.

The questionnaire was used to capture patients’ perceived involvement in decision making. It was developed by the MAGIC team and various clinical teams, including the breast care team. To date, 14 of the 17 eligible patients have completed it and most agree that they received enough information, were informed of the pros and cons of options, and were as involved in decision making as they wanted.

The decision quality measure tool examines patients’ understanding of available treatment options, their preferences, and alignment between their preferences and choices. It was developed by the MAGIC team with the breast care team. Patients complete two decision quality measures. The first (DQM1) is completed at the end of the diagnostic consultation and the second (DQM2) after the home visit.

So far, all 17 eligible patients have completed DQM1, and 13 of these have completed DQM2. Data from DQM1 have generally shown low knowledge and misalignment between preferences and choices. DQM2 data have generally shown improvement in knowledge and alignment, with room for improvement.

Teams report that the questionnaire’s data are less useful to clinical practice than the decision quality measure data. Nurses can use DQM1 as a real-time clinical tool to identify patients’ information needs, preferences, and alignment between preferences and choices, and can use the data to inform the home visit. 

Further reading