Methodological and Interpretative Considerations in ‘Exploring the Patient Engagement in the Healthcare Decision‐Making Process and Its Association With Patients' Satisfaction’

We have read with interest the article by Alharbi et al. (2026) examining patient engagement in healthcare decision-making and its association with satisfaction among chronic disease patients in Saudi Arabia (Alharbi et al. 2026). While the study addresses an important topic in a non-Western context, several methodological and reporting issues warrant clarification. The OPTION scale was originally developed as an observer-rated instrument to assess clinician behaviours in involving patients in decisions (Elwyn et al. 2003). Alharbi et al. administered an Arabic version as a patient-reported questionnaire. This adaptation changes the construct from observed clinician behaviour to patient perception of involvement. The authors do not discuss the validity of this modification, nor provide evidence that the psychometric properties remain comparable when completed by patients immediately after consultations. Clarification is needed regarding the basis for this adaptation. The abstract states that ‘patients generally agreed with statements about their engagement in healthcare decision-making’. However, the reported overall mean score is 2.03 on a 1–5 scale (1 = strongly disagree), which the results section correctly describes as ‘low agreement’. This inconsistency could mislead readers. The Methods section states that ‘all participants filled out and finished the questionnaire entirely, with no missing values in the dataset’. Yet the Results later report that sample sizes varied across analyses ‘due to missing responses for some demographic variables’. The authors should clarify this discrepancy. In table 4 (and related text), some low mean scores are labelled as indicating satisfaction, while higher scores are described as dissatisfaction. No explanation is provided regarding reverse coding or the direction of the Likert scale. Without this clarification, readers cannot confidently interpret the satisfaction findings. The study measured global satisfaction with medical care using the RAND Patient Satisfaction Questionnaire. A well-established distinction exists between decisional satisfaction (satisfaction with the decision-making process) and global care satisfaction (Shay and Lafata 2015). The null association reported may therefore reflect a mismatch between predictor and outcome constructs rather than a true absence of relationship. The sample comprised 90.4% female participants. While the authors note that this reflects clinic attendance patterns, the extreme imbalance limits the applicability of findings to male chronic patients. This is a limitation to generalizability rather than a methodological flaw. In summary, we encourage the authors to clarify the adaptation of the OPTION tool, correct the abstract/result inconsistency, reconcile the missing data reporting, explain the satisfaction scale scoring and discuss the construct mismatch. These clarifications would strengthen the interpretation of their findings. We thank the authors for their valuable contribution and hope these observations support further refinement of SDM research. Meina Zhang conceived the idea for this letter and drafted the manuscript. Huyan Ke provided critical revisions and intellectual input. Both authors approved the final version and are accountable for all aspects of the work. Generative AI Disclosure: Generative AI tools were used solely for language refinement and formatting assistance. All scientific interpretation, critique and conceptual analysis were independently developed by the authors. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.