OPTION — Observing Patient Involvement in Decision Making

Glyn Elwyn, Adrian Edwards, Michel Wensing, Kerenza Hood, Christine Atwell, Richard Grol · 2003

Elwyn et al.'s OPTION scale for observing the clinician behaviours that involve patients in shared decision making.

The OPTION scale ("Observing Patient Involvement") measures the extent to which a clinician involves the patient in shared decision making. The original OPTION-12 rates twelve clinician behaviours, each on a 0-4 magnitude scale (baseline behaviour set at 2). Here the twelve items are grouped into eight annotatable behaviours an agent can find as evidence in a consultation transcript — from defining the problem, through conveying that options exist and weighing their pros and cons, to checking understanding, inviting questions, and offering to defer or review the decision.

Because OPTION is an evidence-mode scale, each behaviour is coded when the clinician exhibits it anywhere in the encounter; the severity value records the OPTION 0-4 extent (how fully the behaviour was performed). All items target the clinician's conduct, not the patient's.

Domains (8)

Problem DefinitionPRB

The clinician identifies and defines the problem(s) that need a decision-making process.

—Curated skill
Options ExistOPT

The clinician conveys that more than one reasonable option exists (equipoise) and lists them, including no action.

—Curated skill
Pros and ConsPRC

The clinician explains the pros and cons (benefits and harms) of the options to the patient.

—Curated skill
Patient ExpectationsEXP

The clinician explores the patient's expectations, ideas, and concerns about how the problem is managed.

—Curated skill
Preferred InvolvementINV

The clinician asks the patient's preferred level of involvement in the decision.

—Curated skill
Check UnderstandingCHK

The clinician checks that the patient has understood the information provided.

—Curated skill
Opportunity to AskASK

The clinician provides opportunities for the patient to ask questions.

—Curated skill
Defer / ReviewDEF

The clinician offers the chance to defer the decision and indicates the need to review it.

—Curated skill
Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: developing the OPTION scale for measuring patient involvement. Qual Saf Health Care. 2003;12(2):93-99. doi:10.1136/qhc.12.2.93

Elwyn et al. 2003 (QSHC); authors state public domain. Operational wording here is grounded in the published items, not reproduced verbatim. Cite Elwyn et al.