Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

  1. Carlos de las Cuevas Castresana
  2. Ingunn Mundal
  3. Moisés Betancort Montesinos
  4. Mariela L. Lara Cabrera
International journal of clinical and health psychology

ISSN: 1697-2600

Year of publication: 2020

Volume: 20

Issue: 3

Pages: 262-270

Type: Article

Export: RIS
DOI: 10.1016/j.ijchp.2020.06.004 DIALNET GOOGLE SCHOLAR lock_openOpen access editor


Background/Objective CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. Method A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. Results Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. Conclusions This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

Bibliographic References

  • Alguera-Lara, V., Dowsey, M. M., Ride, J., Kinder, S., & Castle, D. (2017). Shared decision making in mental health: The importance for current clinical practice. Australasian Psychiatry, 25, 578---582.
  • Angell, B., & Bolden, G. B. (2015). Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations. Social Science & Medicine, 138, 44---56.
  • Barr, P. J., Forcino, R. C., Mishra, M., Blitzer, R., & Elwyn, G. (2016). Competing priorities in treatment decision-making: A US national survey of individuals with depression and clinicians who treat depression. British Medical Journal Open, 6, Article e009585
  • Barr, P. J., Thompson, R., Walsh, T., Grande, S. W., Ozanne, E. M., & Elwyn, G. (2014). The psychometric properties of CollaboRATE: A fast and frugal patient-reported measure of the shared decisionmaking process. Journal of Medical Internet Research, 16, e2.
  • Bravo, P., Contreras, A., Dois, A., & Villarroel, L. (2018). Adapting and validating the generic instrument CollaboRATE to measure women’s participation in health related decision-making during the reproductive process. Atención Primaria, 50, 274---281.
  • Brostrom, A., Pakpour, A. H., Nilsen, P., Hedberg, B., & Ulander, M. (2019). Validation of CollaboRATE and SURE two short questionnaires to measure shared decision making during CPAP initiation. Journal of Sleep Research, 28, Article e12808
  • Calderon, C., Jiménez-Fonseca, P., Ferrando, P. J., Jara, C., Lorenzo-Seva, U., Beato, C., . . . & Carmona-Bayonas, A. (2018). Psychometric properties of the Shared DecisionMaking Questionnaire (SDM-Q-9) in oncology practice. International Journal of Clinical Health Psychology, 18, 143---151.
  • Candia, P. C., & Barba, A. C. (2011). Mental capacity and consent to treatment in psychiatric patients: The state of the research. Current Opinion in Psychiatry, 24, 442---446.
  • Chong, W. W., Aslani, P., & Chen, T. F. (2013). Shared decision-making and interprofessional collaboration in mental healthcare: A qualitative study exploring perceptions of barriers and facilitators. Journal of Interprofessional Care, 27, 373---379.
  • De las Cuevas, C., & Peñate, W. (2014). To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables. Acta Neuropsychiatrica, 26, 372---381.
  • De Las Cuevas, C., & Peñate, W. (2016). Validity of the Control Preferences Scale in patients with emotional disorders. Patient Preference and Adherence, 10, 2351---2356.
  • De las Cuevas, C., Peñate, W., & de Rivera, L. (2014). Psychiatric patients’ preferences and experiences in clinical decisionmaking: examining concordance and correlates of patients’ preferences. Patient Education and Counseling, 96, 222---228.
  • Degner, L. F., Sloan, J. A., & Venkatesh, P. (1997). The Control Preferences Scale. Canadian Journal of Nursing Research, 29, 21---43.
  • Durand, M. A., Carpenter, L., Dolan, H., Bravo, P., Mann, M., Bunn, F., & Elwyn, G. (2014). Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One, 9, Article e94670
  • Elwyn, G., Barr, P. J., Grande, S. W., Thompson, R., Walsh, T., & Ozanne, E. M. (2013). Developing CollaboRATE: A fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Education and Counseling, 93, 102---107.
  • Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., . . . & Barry, M. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27, 1361---1367.
  • Fisher, K. A., Tan, A. S. L., Matlock, D. D., Saver, B., Mazor, K. M., & Pieterse, A. H. (2018). Keeping the patient in the center: Common challenges in the practice of shared decision making. Patient Education and Counseling, 101, 2195---2201.
  • Forcino, R. C., Barr, P. J., O’Malley, A. J., Arend, R., Castaldo, M. G., Ozanne, E. M., . . . & Elwyn, G. (2018). Using CollaboRATE, a brief patient-reported measure of shared decision making: Results from three clinical settings in the United States. Health Expectations, 21, 82---89.
  • Gartner, F. R., Bomhof-Roordink, H., Smith, I. P., Scholl, I., Stiggelbout, A. M., & Pieterse, A. H. (2018). The quality of instruments to assess the process of shared decision making: A systematic review. PLoS One, 13, Article e0191747
  • Grim, K., Rosenberg, D., Svedberg, P., & Schon, U. K. (2016). Shared decision-making in mental health care-A user perspective on decisional needs in community-based services. International Journal of Quality Studies on Health and Well-being, 11, 30563.
  • Hamann, J., Mendel, R., Cohen, R., Heres, S., Ziegler, M., Buhner, M., & Kissling, W. (2009). Psychiatrists’ use of shared decision making in the treatment of schizophrenia: Patient characteristics and decision topics. Psychiatric Services, 60, 1107---1112.
  • Hernández, J. A., & Betancort, M. (2016). ULLRToolbox Retrieved from:.
  • Hofstede, S. N., Marang-van de Mheen, P. J., Wentink, M. M., Stiggelbout, A. M., Vleggeert-Lankamp, C. L., Vliet Vlieland, T. P., . . . & Group, D. S. (2013). Barriers and facilitators to implement shared decision making in multidisciplinary sciatica care: A qualitative study. Implementation Science, 8, 95.
  • Huang, C., Plummer, V., Lam, L., & Cross, W. (2020). Perceptions of shared decision-making in severe mental illness: An integrative review. Journal of Psychiatric and Mental Health Nursing, 27, 103---127.
  • Hurley, E. A., Bradley-Ewing, A., Bickford, C., Lee, B. R., Myers, A. L., Newland, J. G., & Goggin, K. (2019). Measuring shared decision-making in the pediatric outpatient setting: Psychometric performance of the SDM-Q-9 and colaboRATE among English and Spanish speaking parents in the US Midwest. Patient Education and Counseling, 102, 742---748.
  • IBM. (2017). IBM SPSS Statistics for Macintosh, Version 25.0. Armonk Corp. Released. NY: IBM Corp.
  • Jeste, D. V., Eglit, G. M. L., Palmer, B. W., Martinis, J. G., Blanck, P., & Saks, E. R. (2018). Supported Decision Making in Serious Mental Illness. Psychiatry, 81, 28---40.
  • Joosten, E. A., DeFuentes-Merillas, L., de Weert, G. H., Sensky, T., van der Staak, C. P., & de Jong, C. A. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77, 219---226.
  • Kalsi, D., Ward, J., Lee, R., Fulford, K., & Handa, A. (2019). Shared decision-making across the specialties: Much potential but many challenges. Journal of Evaluation in Clinical Practice, 25, 1050---1054.
  • Kew, K. M., Malik, P., Aniruddhan, K., & Normansell, R. (2017). Shared decision-making for people with asthma. Cochrane Database of Systematics Reviews, 10, Article CD012330
  • Legare, F., & Thompson-Leduc, P. (2014). Twelve myths about shared decision making. Patient Education and Counseling, 96, 281---286.
  • Moran-Sanchez, I., Gomez-Valles, P., Bernal-Lopez, M. A., & PerezCarceles, M. D. (2019). Shared decision-making in outpatients with mental disorders: Patients preferences and associated factors. Journal of Evaluation in Clinical Practice, 25, 1200---1209.
  • Muñiz, J., & Fonseca-Pedrero, E. (2019). Ten steps for test development. Psicothema, 31, 7---16.
  • Norful, A. A., Dillon, J., Baik, D., George, M., Ye, S., & Poghosyan, L. (2020). Instruments to measure shared decisionmaking in outpatient chronic care: A systematic review and appraisal. Journal of Clinical Epidemiology, 121, 15---19.
  • Perestelo-Perez, L., Rivero-Santana, A., Perez-Ramos, J., Gonzalez-Lorenzo, M., Roman, J. G., & Serrano-Aguilar, P. (2011). Shared decision making in Spain: current state and future perspectives. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 105, 289---295.
  • Phillips, N. M., Street, M., & Haesler, E. (2016). A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. British Medical Journal Quality and Safety, 25, 110---117.
  • Pieterse, A. H., Stiggelbout, A. M., & Montori, V. M. (2019). Shared Decision Making and the Importance of Time. Journal of the American Medical Association, 322, 25---26.
  • R Core Team. (2019). R: A language and environment for statistical computing URL. Vienna: R Foundation for Statistical Computing.
  • Revelle, W. (2018). psych: Procedures for Personality and Psychological Research. Evanston, Il: Northwestern University. Version = 1.8.12.
  • Rodenburg-Vandenbussche, S., Carlier, I., van Vliet, I., van Hemert, A., Stiggelbout, A., & Zitman, F. (2019). Patients’ and clinicians’ perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. Journal of Evaluation in Clinical Practice,
  • Rosenberg, D., Schon, U. K., Nyholm, M., Grim, K., & Svedberg, P. (2017). Shared decision making in Swedish community mental health services an evaluation of three selfreporting instruments. Journal of Mental Health, 26, 142---149.
  • Ruiz Yanzi, M. V., Barani, M. S., Franco, J. V. A., Vazquez Pena, F. R., Terrasa, S. A., & Kopitowski, K. S. (2019). Translation, transcultural adaptation, and validation of two questionnaires on shared decision making. Health Expectations, 22, 193---200.
  • Scholl, I., Koelewijn-van Loon, M., Sepucha, K., Elwyn, G., Legare, F., Harter, M., & Dirmaier, J. (2011). Measurement of shared decision making a review of instruments. Zeitschrift für Evidenz, Fortbildung und Qualitat im Gesundheitswesen, 105, 313---324.
  • Seale, C., Chaplin, R., Lelliott, P., & Quirk, A. (2006). Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences. Social Science & Medicine, 62, 2861---2873.
  • Sepucha, K. R., & Scholl, I. (2014). Measuring shared decision making: A review of constructs, measures, and opportunities for cardiovascular care. Circulation: Cardiovascular Quality and Outcomes, 7, 620---626.
  • Shay, L. A., & Lafata, J. E. (2014). Understanding patient perceptions of shared decision making. Patient Education and Counseling, 96, 295---301.
  • Simmons, M., Hetrick, S., & Jorm, A. (2010). Shared decisionmaking: benefits, barriers and current opportunities for application. Australasian Psychiatry, 18, 394---397.
  • Slade, M. (2017). Implementing shared decision making in routine mental health care. World Psychiatry, 16, 146---153.