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106 Measurement of shared decision making automatically and in real-time: a mixed-methods usability study
  1. Christin Hoffmann1,
  2. Kerry Avery1,
  3. Rhiannon Macefield1,
  4. Tadeas Dvorak1,
  5. Val Snelgrove2,
  6. Hilary Bekker3,4,
  7. Jane M Blazeby1,5,
  8. Angus GK Mcnair1,6,
  9. on behalf of the Alpaca Study team
  1. 1National Institute for Health Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
  2. 2Patient representative, Bristol, UK
  3. 3Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
  4. 4The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Central Denmark Region, Denmark
  5. 5Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  6. 6North Bristol NHS Trust, Bristol, UK


Introduction High-quality shared decision making(SDM) is a policy and patient priority for modern healthcare systems. Optimal ways to achieve organisation-wide, sustained improvements in SDM processes are lacking.1 2 Electronic measurement allows large-scale, real-time monitoring of patients’ experiences of SDM and may facilitate timely interventions to improve SDM. This work explored the usability of an automated measurement system to monitor surgical patients’ experience of the SDM process.

Methods This mixed-methods study evaluated the usability of an automated measurement system monitoring surgical patients’ SDM experience in a large hospital. System effectiveness, efficiency and user satisfaction were assessed following ISO guidelines.3 Online questionnaires (CollaboRATE,SDM-Q-9) measured patients’ experience of SDM before surgery. All urgent/elective surgery patients across seven specialties received invitations. Patients without capacity and those undergoing emergency/endoscopic procedures were excluded. User testing sessions and semi-structured interviews with patients were conducted.

Results Some 5,794 surgical patients received invitations to complete the measurement system. Task completion was high (99%) and the survey response rate was good (39%). Median task completion time was 3 minutes (IQR:2,13), suggesting good system efficiency and effectiveness. Nine testing sessions and 16 interviews explored views of 25 patients. The system was perceived as acceptable, easy to access/use, indicating good user satisfaction. Patients identified potential barriers and solutions to usability.

Discussion Knowledge of usability of a novel approach to monitor SDM surgical patients’ SDM experience routinely and at large scale informed strategies to optimise and implement the system in other healthcare institutions.

Conclusion(s) A mixed-method evaluation of an electronic system for automated, real-time measurement of patients’ experience of SDM processes showed that usability amongst patients was high. Findings will be used to develop timely interventions to improve SDM before surgery.


  1. Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, et al. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane database Syst Rev. 2018;7:CD006732.

  2. National Institute for Health and Care Excellence. Shard decision making [NG197]. Evidence reviews 2021. NICE; 2021.

  3. ISO. ISO 9241–11:2018(en), Ergonomics of human-system interaction — Part 11: Usability: Definitions and concepts. 2018. P: 9241(11).

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