Abstract
Importance
Shared decision-making (SDM) improves patient adherence and may reduce costs, yet its adoption remains limited. A brief, valid, and practical measure of clinicians’ willingness to adopt SDM is needed to support implementation efforts and research.
Objective
To refine and improve the incorpoRATE measure of clinician willingness to incorporate shared decision-making.
Design, Setting, and Participants
Cognitive interview study conducted via video conference with physicians, nurse practitioners, and physician assistants working in primary care in rural New Hampshire, recruited through the Northern New England Practice and Community-Based Research Network (NNE CO-OP), October to December 2024.
Main Outcomes and Measures
Item-level feedback on clarity, interpretability, and social desirability of measure items; participant-rated willingness scores (0–10 scale) for each item.
Results
Cognitive interviews across two rounds with 16 health professionals (9 physicians, 6 nurse practitioners, 1 physician assistant) confirmed that further modifications were required to the measure. Changes reduced potential social desirability introduced by certain word choices and modified the question stems and response scale.
Conclusions and Relevance
Refinements improved incorpoRATE's clarity and applicability, with slightly higher and similar-more variable mean willingness scores (8.33, SD = 1.3) than earlier versions. A further version of the measure is now available for clinical validation.