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Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients

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  • Ali Ben Charif

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
    Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
    Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada)

  • Jordie Croteau

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
    Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada)

  • Rhéda Adekpedjou

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada)

  • Hervé Tchala Vignon Zomahoun

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada)

  • Evehouenou Lionel Adisso

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada)

  • France Légaré

    (Centre de recherche sur les soins et les services de première ligne, Université Laval, Quebec, QC, Canada
    Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
    Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
    Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada)

Abstract

Background. Cluster randomized trials are important sources of information on evidence-based practices in primary care. However, there are few sources of intracluster correlation coefficients (ICCs) for designing such trials. We inventoried ICC estimates for shared decision-making (SDM) measures in primary care. Methods. Data sources were studies led by the Canada Research Chair in Shared Decision Making and Knowledge Transition. Eligible studies were conducted in primary care, included at least 2 hierarchical levels, included SDM measures for individual units nested under any type of cluster (area, clinic, or provider), and were approved by an ethics committee. We classified measures into decision antecedents, decision processes, and decision outcomes. We used Bayesian random-effect models to estimate mode ICCs and the 95% highest probability density interval (HPDI). We summarized estimates by calculating median and interquartile range (IQR). Results. Six of 14 studies were included. There were 97 ICC estimates for 17 measures. ICC estimates ranged from 0 to 0.5 (median, 0.03; IRQ, 0–0.07). They were higher for process measures (median, 0.03; IQR, 0–0.07) than for antecedent measures (0.02; 0–0.07) or outcome measures (0.02; 0–0.06), for which, respectively, “decisional conflict†(mode, 0.48; 95% HPDI, 0.39–0.57), “reluctance to disclose uncertainty to patients†(0.5; 0.11–0.89), and “quality of the decision†(0.45; 0.14–0.84) had the highest ICCs. ICCs for provider-level clustering (median, 0.06; IQR, 0–0.13) were higher than for other levels. Limitations. This convenience sample of studies may not reflect all potential ICC ranges for primary care SDM measures. Conclusions. Our inventory of ICC estimates for SDM measures in primary care will improve the ease and accuracy of power calculations in cluster randomized trials and inspire its further expansion in SDM contexts.

Suggested Citation

  • Ali Ben Charif & Jordie Croteau & Rhéda Adekpedjou & Hervé Tchala Vignon Zomahoun & Evehouenou Lionel Adisso & France Légaré, 2019. "Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients," Medical Decision Making, , vol. 39(6), pages 661-672, August.
    • Handle: RePEc:sae:medema:v:39:y:2019:i:6:p:661-672
    DOI: 10.1177/0272989X19866296
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    References listed on IDEAS

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    1. Larizgoitia, Itziar & Starfield, Barbara, 1997. "Reform of primary health care: the case of Spain," Health Policy, Elsevier, vol. 41(2), pages 121-137, August.
    2. Mireille Guerrier & France Légaré & Stéphane Turcotte & Michel Labrecque & Louis-Paul Rivest, 2013. "Shared Decision Making Does Not Influence Physicians against Clinical Practice Guidelines," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-7, April.
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