Key result
New ICD decision quality scale demonstrates moderate internal validity and strong test-retest reliability.
Why the study?
CMS reimbursement guidelines mandate shared decision making for ICDs without any method to assess decision quality, prompting development of a scale to evaluate patient knowledge and preferences.
Cross-Sectional (n=349)
The newly developed ICD-DQ scale is a valid and reliable tool for assessing patient knowledge and preferences regarding primary prevention ICDs, facilitating shared decision making.
BACKGROUND: CMS reimbursement guidelines for implantable cardioverter-defibrillators (ICDs) include mandated shared decision making (SDM), but without any manner of assessing the quality of decisions made. We developed and tested a scale meant to assess patients' knowledge of and preferences specific to ICDs. Such a tool would assess these constructs in the clinical environment, targeting resources and support for patients considering a primary prevention ICD. METHODS: Development of the ICD decision quality (ICD-DQ) scale included (1) item creation, (2) content validation using surveys of patients (n = 23) and clinicians (n = 31), and (3) examination of validity and reliability using a survey of patients who previously received an ICD (n = 295, response rate = 72%). RESULTS: The final scale consists of 12 knowledge and 8 preference items. With respect to content validity, clinician and patient respondents agreed on the importance of 19 of 24 candidate knowledge items (79%), and 9 of 11 treatment preference items (81%). Knowledge items exhibited moderate internal validity (α = 0.62, 1 factor), strong test-retest reliability (mean % correct at first administration = 59%, 62% at follow-up, P > .1) and discriminant validity (59% correct for patients, 93% among cardiologists). Short versions of the ICD-DQ were developed for clinical settings, the scores from both of which correlated with the long version in this cohort (11-item (r = 0.90) and a 5-item (r = 0.75)). CONCLUSIONS: The ICD-DQ fills a critical gap in measuring the quality of patients' ICD decisions. They may be used to evaluate the effectiveness of patient decision aids or the quality of SDM in clinical practice.
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Knoepke et al. (2021) conducted a cross-sectional in Primary prevention implantable cardioverter-defibrillator (ICD) decision making (n=349). ICD decision quality (ICD-DQ) scale was evaluated on Scale validity and reliability. The newly developed ICD decision quality (ICD-DQ) scale demonstrated moderate internal validity (α = 0.62) and strong test-retest reliability (59% vs 62% correct; P > 0.1).
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