Patient Satisfaction with Health Care Decisions: The Satisfaction with Decision Scale MARGARET HOLMES-ROVNER, PhD, JILL KROLL, PhD, NEAL SCHMITT, PhD, DAVID R. ROVNER, MD, M. LYNN BREER, MA, MARILYN L. ROTHERT, PhD, RN, FAAN, GEORGIA PADONU, PhD, RN, GERALDINE TALARCZYK, EdD, RN Patient satisfaction measures have previously addressed satisfaction with medical care, satisfaction with providers, and satisfaction with outcomes, but not satisfaction with the health care decision itself. As patients become more involved in health care decisions, it is important to understand specific dynamics of the decision itself. The Satisfaction with Decision (SWD) scale measures satisfaction with health care decisions. It was developed in the context of postmenopausal hormone-replacement therapy decisions. The six-item scale has excellent reliability (Cronbach’s alpha = 0.88). Discriminant validity, tested by performing principalcomponents analysis of items pooled from the SWD scale and two conceptually related measures, was good. Correlation of the SWD scale with measures of satisfaction with other aspects of the decision-making process showed the SWD scale was correlated most highly (0.64) with “decisional confidence,” and least with “desire to participate in health care decisions” and “satisfaction with provider.” The SWD scale predicts decision certainty in this study. Use in an independent study showed that the SWD scale was correlated with the likelihood of patients’ intentions to get a flu shot. Further investigation in relation to other health decisions will establish the utility of the SWD scale as an outcome measure. Key words: patient satisfaction; medical decision making; decision support. (Med Decis Making 1996;16:56-64)
three models of decision support for perimenopausal hormone-replacement therapy. The SWD scale was 1) an outcome measure to evaluate the results of the trial and 2) a descriptive measure to explain compliance with whatever decision the woman made. Data describe satisfaction with the health care decision at the time when a decision has been m a d e but the consequences have not yet occurred. The SWD scale builds on O’Connor and O’BrienPallas’ conceptual model of an effective decision,l i.e., one that is informed, consistent with the decisionmaker’s values, and behaviorally implemented. The purposes of the SWD scale are 1) to measure global satisfaction with the decision and the three attributes of an effective decision (from the O’Connor model); 2) to differentiate satisfaction with the decision from related aspects of satisfaction (satisfaction with provider, desire to participate in decision); and 3) to be short and easy to use.
Patient decision making is an increasingly important
area of research. Traditionally, such research has focused on the patient’s role in treatment, exemplified by the compliance literature. The patient has been viewed as a passive vehicle, whose role is to carry out a specified treatment regimen. More recently, patients have been described as health care consumers to be satisfied. A middle ground views patients and providers as working collaboratively in complex decision environments. Their task is to pick a satisfactory path among treatment alternatives, none of which is perfect from the point of view of the patient, the provider organization, the family, or the national budget for health care. More research is needed to explain the dynamics of patient decision making as well as to develop outcome measures for decision aids. The Satisfaction with Decision (SWD) scale is a new measure. We report its use in a randomized trial of Received October 6, 1994, from the Department of Medicine, Department of Psychology, and College of Nursing, Michigan State University, East Lansing, Michigan. Revision accepted for publication January 6, 1995. Address correspondence and request reprints to Dr. HolmesRovner: Department of Medicine, B220 Life Sciences Building, Michigan State University, East Lansing, MI 48824-1317.
Need for a New Measure We developed and validated the Satisfaction with Decision scale to address a problem in the literature on patient satisfaction and desire to participate in de58
VOL 16/NO 1, JAN-MAR 1996
cision making. Early research on patient involvement did not adequately differentiate the models underlying the research or define the kinds of decisions being studied. The need for better specification-of decision problems is illustrated by a study by Ende et al.,’ in which they investigated patients’ desires to participate in medical decisions and showed that most patients preferred to delegate decision making to physicians. However, the Ende instrument does not differentiate between patient decisions about outcomes as opposed to treatments, and it is limited to decisions in the acute care setting. The instrument asks respondents to read a scenario and imagine they are having a heart attack and are taken to the intensive care unit. Respondents are asked who should make various decisions, including “How often nurses in the intensive care unit should wake you up to take your temperature and blood pressure.” While this addresses a patient concern, it is very different from decisions about goals for treatment outcomes. Furthermore, the treatment decision itself is a fundamentally different type of decision from preventive decisions about whether to get a flu shot or take hormones in menopause. 3,4 Deber et a1.,55 in a study of 416 patients scheduled for angiography, found that patients may wish to participate in decisions about outcomes, but not in decisions that are part of the medical problem-solving process. They found that 98% of the patients wanted their physicians to make decisions that involved diagnosis, treatment options, and estimates of probabilities. Seventy-eight percent of the same patients, however, wanted to be involved in questions of treatment choice and in evaluating outcomes. Patient involvement in decision making is consistent with “deliberative models” of patient-provider interaction.’ The deliberative model, like the decision-analytic model, assumes that a choice is to be made and that it should be based on critical evaluation of existing medical evidence and on patient values for outcomes. The SWD scale was designed for such situations, although it does not assume high patient involvement. Questions are framed so that the patient can decide to delegate decisions, with the exception of one question, which ask6 about being satisfied that this was the patient’s decision to make. The measure is particularly important as an outcome measure for interventions designed to support patients in explicit decision making. The SWD scale was developed to evaluate a decision-support intervention to assist women in decision making about hormone-replacement therapy (HRT). The results of the intervention study are reported elsewhere?’ In addition to patient decisionsupport interventions, informed consent and other clinical interactions requiring patient decision making may be evaluated using the SWD. We developed the SWD in a randomized intervention trial of three models of decision support; 1) bro-
The Satisfaction with Decision Scale
l
59
chure only, 2) lecture-discussion, and 3) active decision support. All were followed over 12 months. The intervention attempted not to prescribe a correct decision, but to encourage women to make the decisions that were most in keeping with their own values.
Evaluation Design The SWD measure, as a specific measure of satisfaction with a decision, needed to be different from other related measures of satisfaction. In our study, decisional conflict was measured by a scale developed by O’Connor. 9 Decisional confidence was assessed using a measure designed by Estes and Hosseini.l0 Satisfaction with provider was measured using the measure of that name devised by Linder-Pelz and Struening.11 Desire to participate was measured using the method of Strull, Lo, and Charles.” The knowledge tests were developed for this study by the investigators, as was the Health Status Restriction (HSR) scale. Scales to measure perceived knowledge of menopause and objective knowledge of menopause were developed for this study to investigate the relationship between the SWD scale scores and knowledge of the risks and benefits of HRT. We hypothesized that the SWD scale score should be largely independent of scores for satisfaction with provider and desire to participate. It should be negatively correlated with decision conflict (the extent of uncertainty and confusion in choosing a course of action). It should be positively correlated with decision confidence, although, theoretically, a patient could be satisfied with a decision in the sense that it was the best among bad alternatives and still not be highly confident of the health outcome. The SWD scale is designed not to assume a good health outcome, but to measure satisfaction with the decision, however good or bad the prognosis. It is possible to be satisfied with a decision leading to death, although for many people, the decision and the outcome become one and the same. A main outcome measure for the intervention study was a measure we called “decision certainty” to allow the decision maker to be either very positive or very negative about the decision, in this case the decision to take hormonereplacement therapy. The impact of the decision-support intervention was measured, in part, by the changes in participants’ ratings of their certainty about taking hormone-replacement therapy. The participants were asked to indicate how likely they were to take hormone-replacement therapy. The response frame was a five-point scale from 1, very certain would not take, to 5, very certain would take. We later recoded the scale to form a threepoint scale, Decision Certainty, so that “very certain” in either direction was coded 3 (high certainty), “probably would” or “probably would not” was coded 2
60 l Holmes-Rovner, Kroll, Schmitt, Rovner, Breer, Rothert, Padonu, Talarczyk
(moderate certainty), and “may or may not” was coded 1 (least certain). The relationship between decision certainty and satisfaction with the decision is not a measure of the reliability or validity of the SWD scale. However, the correlation of the SWD scale score with decision certainty and, subsequently, self-reported acceptance of HRT was investigated to explore the usefulness of the SWD scale in predicting actions taken on decisions. In order to provide a rigorous test of discriminant validity, we pooled items from the SWD scale and the conceptually most similar scale, O’Connor’s Decisional Conflict (DC) scale,’ which uses the same general conceptual model. The Health Status Restriction (HSR) measure was included to test the hypothesis that satisfaction with the decision was confounded by perceived inability to make a decision for health status reasons. The items from all three scales were subjected to principal-components analysis to determine the uniqueness of the SWD scale relative to the other two scales. The SWD scale was said to discriminate if items on the latter two scales loaded on factors other than the factors on which SWD scale items loaded. The principal-components analysis used a varimax rotation of the three orthogonal factors.
tion with potential good or bad outcomes were not internally consistent, and were dropped. Two decision-specific items measuring perception of being informed performed well, but are not included in the generic SWD scale. These two items are: “I know all the possible choices open to me in protecting my health after menopause” and “I understand the risks and benefits of taking hormone replacement therapy.” These two items form a reliable scale (alpha = 0.71), highly correlated with the SWD scale score.
Sample The study participants were volunteers, recruited through the local press. They were women 40 years old or older who wanted more information to help them make decisions about management of menopause and HRT. The women in the sample (n = 2.52) were somewhat more likely to be white, to be collegeeducated, and to have relatively high household incomes than the average woman in the surrounding metropolitan area. The surrounding tri-county area was 5.3% African American; the study sample was 3.6% African American. No woman of any other ethnic minority participated in the study. Yearly household incomes were between $15,000 and $99,999 (86% ). Fiftyeight percent of the women were still having regular menstrual periods, but 59% were currently experiencing symptoms of menopause or had experienced such symptoms in the past. The participants in all arms of the study completed the Satisfaction with Decision, Decisional Conflict, Decisiony Confidence, Satisfaction with Provider, Desire to Participate, Perceived Knowledge, Health Status Re-
Instrument Development To establish initial reliability of the instrument, we conducted a pilot study with a convenience sample of women (n = 120) recruited from the faculty and staff of Michigan State University. The SWD scale (see appendix) performed reliably in the pilot study (Cronbath’s alpha = 0.88). Three items measuring satisfacTable 1
l
MEDICAL DECISION MAKING
Responses of the Study Subjects (252 Women) on Eight Scales of Satisfaction Response Scale Score SD Mean
No. items
Alpha
Satisfaction with Decision scale
6
0.86
l-5 (5 = higher satisfaction)
3.9
0.60
Decisional Conflict scale (uncertainty subscale)
3
0.77
l-5 (5 = higher conflict)
2.8
0.98
Health Status Restrictions scale
3
0.77
l-5 (5 = higher restrictions)
2.2
0.81
Satisfactioh ‘with Provider scale
10
0.92
l-5 (5 = higher satisfaction)
3.4
0.77
Desire to Participate scale
1
N/A
1 2 3 4 5
3.6
0.86
Confidence in Decision scale
1
N/A
l-10 1 = no confidence at all 10 = complete confidence
7.4
2.2
24
0.85
l-24 (24 = higher knowledge)
20.9
2.6
2
0.71
l-5 (5 = higher perceived knowledge)
3.5
0.78
Knowledge of menopause scale Perceived knowledge scale
Response Scale Range
= patient should decide = patient w/opinion = patient/practitioner equally = practitioner w/opinion = practitioner should decide
VOL 16/NO 1, JAN-MAR 1996
Table 2
l
The Satisfaction with Decision Scale 0 61
Intercorrelations among Variables in the Study of 252 Women’s Responses to Scales Measuring Satisfaction
Knowledge (7)
0.21*
-0.12*
-0.15*
0.05
Perceived Knowledge (8) Education (10)
0.48*
-0.32*
-0.15*
0.11
-0.03
0.47*
0.21*
0.22*
-0.07
- 0.20*
0.05
- 0.30*
0.21*
0.31*
0.02
-0.08
0.07
-0.19*
0.07
0.21*
0.05
-0.03
Income (11)
0.12*
0.01*
-0.14*
-0.19*
0.27*
0.28*
*p < 0.05. striction, and Knowledge of Menopause scales, as well as a demographic questionnaire including questions about education and income.
erately with the Decisional Conflict scale ( - 0.54), as anticipated, and positively with the Confidence in Decision scale (0.64) and the Perceived Knowledge of Menopause scale (0.48).
Results
DOES THE SWD SCALE MEASURE A UNIQUE CONSTRUCT?
SCALE DESCRIPTIONS Table 1 shows the response mean, standard deviation, and Cronbach’s alpha for each scale used. Note that the Decisional Conflict scale is a three-item scale in which higher values indicate more conflict. Desire to participate in the decision is measured on a fivepoint scale, with 1 indicating the patient should make the decision and 5 indicating the provider should make the decision (intermediate points represent degrees of collaboration). All 252 subjects completed all items in the SWD scale, unlike any other of the questionnaires. Clearly the scale is short and easy to use. The instrument vocabulary is at an eighth-grade reading level.‘” As was true in the pilot study, the reliability of the SWD scale was good, Cronbach’s alpha = 0.86. CORRELATIONAL RESULTS Table 2 contains the correlations among measures. The SWD scale correlated significantly with all the variables except income, although most correlations were low. It correlated weakly with the education (0.22), Satisfaction with Provider (0.231, and Knowledge of Menopause (0.21) scales, the latter being an objective knowledge measure. The SWD scale correlated mod-
The results of the principal-components analysis of the SWD, Decisional Conflict, and Health Status Restriction Decision scale items appear in table 3. Since each item’s highest loading was with the scale for which it was written, and loadings with the other scales were relatively low for all 12 items, these three constructs as measured appear to be empirically as well as conceptually discriminable. Because the correlation between the SWD scale and the DC and HSR scales: is modest, we considered it important to correct for unreliability to see whether the correlation persisted. 14 The correction for attenuation due to unreliability provides an estimate of the correlation between the two constructs involved when variance due to measurement error is removed. If they continue to be modestly correlated, the constructs may be considered distinct, but related. The SWD and DC scales correlated -0.66 after correction for attenuation, which indicates that about 44% ( - 0.662) of the reliable variance in these measures is shared and that the remaining 56% of the variance in each is unique. The HSR scale correlated -0.35 when corrected for attenuation, showing 12% shared variance. While there is no rule to determine the level of intercorrelation needed to conclude that two constructs are discrim-
62
l
Holmes-Rovner, Kroll, Schmitt, Rovner, Breer, Rothert, Padonu, Talarczyk
Table 3
l
Factor Loading of Three Scales--Satisfaction with Decision (SWD), Decisional Conflict (DC), and Restricted Decision (RD) SWD
DC
RD
0.831 0.807 0.773 0.749 0.667 0.578
- 0.269 0.086 -0.104 - 0.397 - 0.401 - 0.325
- 0.073 -0.149 - 0.086 - 0.082 -0.120 - 0.045
SWDl. SWD2. SWD3. SWD4. SWD5. SWD6.
Consistent with values My decision to make Expect to carry out Best decision for me Satisfied with decision Satisfied informed
DC1 .
Unsure what to do Decision is hard to make Clear what choice is best
- 0.208 - 0.099
0.817 0.790
0.171 0.192
- 0.328
0.728
0.009
Health status restriction: exercise Health status restricted: calcium Health status restricted: HRT*
- 0.094
0.059
0.868
-0.013
0.1.3
0.864
-0.177
0.155
0.603
4.83
1.74
1.28
40.3%
14.5%
10.6%
DC2. DC3. RDl. RD2. RD3.
Eigenvalue Variance explained
*HRT = hormone-replacement therapy.
inable, we believe the levels of the corrected correlations provide evidence that these three measures index meaningfully different constructs. In summary, the internal consistency of each of these three scales, the observed correlation between the scales, and their intercorrelations corrected for attenuation due to unreliability indicate that the scales measure discriminable constructs, although the SWD scale is clearly related to the Decisional Conflict scale. RESPONSE BIAS Any satisfaction measure is vulnerable to the possibility that the concept itself evokes a response biased in a positive direction. One solution sometimes used is to word items negatively. However, our prior work had indicated that this is more likely to confuse participants and decrease reliability than to reliably center the distribution of responses. 15 In administering items in other scales with directional shifts, we have found that people ask questions for clarification and become confused in filling out questionnaires. While the mean of the SWD scale scores (3.9) is above the midpoint, the large standard deviation (0.66) and the distribution of the scores by likelihood to take estrogens in this study indicate that the women did not simply express global satisfaction. Further, it should be noted that the participants who were very certain either to take or not to take estrogens were more satisfied with their decisions than were those who were less certain.
MEDICAL DECISION MAKING
PREDICTING DECISIONS. To examine the relationship between SWD scale scores and actual decision making, we followed a twostep analysis necessitated by the difficulty of collecting behavioral data. The number of women taking HRT was collected from daily menopause-management calendars that the participants filled out for 12 months. Women who entered HRT on their calendars at 1 2 months were considered to be taking HRT. Those who did not so record HRT were considered not to be taking HRT. The calendar data had missing data points, resulting from the high level of motivation required from participants to complete the calendars even with telephoned reminders from the investigators (complete calendar data at 12 months, n = 63). The Decision Certainty scale, a proxy for behavior, had the advantage that we had complete data for all research participants (n = 252). To address the relationship of HRT taking and the SWD scale score, we first examined the correlation of the Decision Certainty and SWD scale scores. We then tested the quality of the DC scale score proxy by examining the relationship between decision certainty and HRT taking for the participants for whom we had calendar data. These calendar data offer insights into the decision process and subsequent behavior, recognizing that the results are probably the best-case scenario. Satisfaction with the decision (SWD scale scores) and decision certainty were significantly correlated (r = 0.27, p < 0.05) at 12 months. The numbers of women showing HRT on their calendars at month 12 by level of certainty appear in table 4. Thirty-one women who had said they were very certain to take HRT did so, while five women at other levels of certainty did so. The women who returned their calendars but did not take HRT were distributed across all levels of certainty, especially across the three middle points, indicating “probably, or maybe” taking HRT. This suggests that people have t o be very certain and very satisfied with their decisions to actually follow them. To investigate further the usefulness of our measures to predict decision certainty, we used stepwise multiple regression, recognizing that the collinearity among these scales (see table 2) produces some amTable 4
l
Numbers of Peri/postmenopausal Women (n = 63) Taking Hormone-replacement Therapy (HRT) during Month 12 by Certainty about HRT Decision*
Very certain would not take HRT Probably would not take HRT May or may not take HRT Probably would take HRT Very certain would take HRT
HRT Not on Calendar
HRT on Calendar
3 8 9 5 2
1 0 1 3 31
*Missing data due to non-returned calendars at 12 months. Pearson chisquare = 40.93, df = 4, p < 0.05.
VOL 16/NO 1. JAN-MAR 1996
biguity with respect to the relative importance of each of these predictors of uncertainty. We limited the analysis to the subsample of women no longerhaving menstrual periods, for whom the decision to take HRT was clearly feasible (n = 89). All the variables in the correlation matrix in table 2 were used, substituting the mean for missing values. The SWD scale score contributed the most to predicting decision certainty. Knowledge added some additional predictive value. No other variable contributed significantly to prediction certainty. Certainty = -0.47 -I- 0.31 SWD + 0.8 knowledge (r = 0.38, F = 7.11, p < 0.05) If the SWD scale score is removed from the analysis, the Decisional Conflict scale score becomes the only significant predictor in addition to the knowledge scores, indicating that both are reasonable predictors of decision certainty.
Use in Other Settings An independent study using the SWD scale was carried out by O’Connor’ in a study of the decisions of elderly patients regarding influenza immunization. Three groups in Ottawa, Ontario, Canada, were studied: 1) health science students (n = 151); 2) health employees at a teaching hospital and at a visiting nursing agency (n = 115); and 3) patients with cardiac or respiratory disorders (n = 283). In the O’Connor study, the reliability of the SWD scale was alpha = 0.85. In addition, among the patient group, the SWD discriminated between those patients who were sure about what they would do (i.e., strong intentions to be immunized or strong intentions not to be immunized) and those who ‘were less sure about what they would do (intermediate intentions to be immunized).
Discussion The six-item SWD scale is a reliable and valid instrument that measures patient satisfaction with a health care decision. The brief scale provides an efficient measure that can be easily used in health care settings to evaluate decision-assisting technologies or patient-provider interactions aimed at involving patients in decision making. Findings from this study indicate that the SWD scale uniquely measures satisfaction with a decision and that it does predict patients’ levels of certainty that they will carry out the decision. Most expressions of uncertainty appear to lead to non-action. The SWD scale score correlated with lower levels of decisional conflict and higher confidence in the decision, two
The Satisfaction with Decision Scale s 63
constructs expected to influence behavioral outcomes of the decision. Interestingly, the SWD scale score correlated much more highly with perceived knowledge than with actual knowledge of menopause, suggesting that factual knowledge alone may have little relationship to satisfaction with the decision. Since the SWD scale score predicts behavioral intention, it is important to explore the implications of the finding that information and education alone may play a small role in patients’ reaching decisions they can live with. The scale was independent of symptom status, making it useful for patients with a wide array of health states. The low, but significant, correlation of the Desire to Participate scale score with the SWD scale score suggests that the patients who wanted to participate in decision making were more satisfied. This finding is hard to interpret because of the skewed nature of the participation data. In our sample, only 10% of the women wanted the practitioner alone to make the decision. Ninety percent of the women wanted to make the decision by themselves or equally with the provider. The weak correlation of the SWD scale score with the Desire to Participate score indicates that the scale is relatively independent of desire to participate. The SWD scale should perform as well for patients who prefer to delegate decision making to providers or family as it did for the information-seeking participants in our study. Further work in this area might profitably pursue the relationship of desire to participate in decision making and satisfaction with the decision, since desire to participate is not correlated with decisional conflict. To date, the SWD scale has performed well in decision making about taking HRT during menopause and about getting a flu shot. We suggest that half a standard deviation (0.5) is a meaningful effect size to reflect a change in satisfaction with a decision using the SWD scale score as an outcome measure. We were not able to directly investigate HRT taking. However, the likelihood to take HRT (Decision Certainty scale) served as a reasonable proxy in this case. Patient decision making research is critical to improving the quality of health care delivery and to improving health care outcomes. The six-item SWD scale measures satisfaction with the decision at the point at which a health care decision has been made and the consequences have not yet been experienced. Data indicate that the SWD scale is closely related to the patient’s intent to act, thus providing an important measure of a factor expected to influence health care outcomes.
References 1. O'Connor A, O’Brien-Pallas
LL. Decisional conflict. In: McFarland GK, McFarlane EA, eds. Nursing Diagnosis and Intervention. Toronto, Ontario, Canada: C. V. Mosby, 1989, p 573.
64 l Holmes-Rovner, Kroll, Schmitt, Rovner, Breer, Rothert, Padonu, Talarczyk 2. Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989;4:23. 3. Rothert ML, Rovner DR, Holmes M, et al. Women’s use of information regarding hormone replacement therapy. Res Nurs Health. 1990;13:355. 4. Rothert ML, et al. Menopausal women as decision makers in health cam. Exp Gerontol. 1994;29:463. 5. Deber R, Kraetschmer N, Irvine J. What mle do patients wish in treatment decision making? Med Decis Making. 1993;13:384. 6. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267:2221. 7. Rothert ML, Kroll J, Holmes-Rovner M, et al. Communicating Risks and Benefits to Midlife Women. Proceedings, U.S. Pharmacopeia, 1994. 8. Kroll JC, Rothert ML, Rovner DR, et al. Decision support intervention: mom is not necessarily better. Med Decis Making. (in press). 9. O’Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1994;14:440. 10. Estes R, Hosseini J. The gender gap on Wall Street: an empirical analysis of confidence in investment decision making. J Psychol. 1988;12:577. 11. Linder-Pelz S, Struening EL. The multidimensionality of patient satisfaction with a clinic visit. J Community Health. 1985;10:42. 12. Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990. 13. Que Software. Rightwriter User Manual. Cannel, IN, 1990. 14. Edwwards, AL. Statistical Methods for the Behavioral Sciences. New York: Holt, Reinhart, Winston, 1954. 15. Schmitt N, Stults DM. Factors defined by negatively keyed items: the result of careless respondents? Appl Psycho1 Meas. 1985;9:367.
MEDICAL DECISION MAKING APPENDIX
Satisfaction with Decision Instrument You have been considering whether to consult your health care provider about hormone-replacement therapy. Answer the following questions about your decision. Please indicate to what extent each statement is true for you AT THIS TIME. Use 1 2 3 4 5
the following scale to answer the questions. = strongly disagree = disagree = neither agree nor disagree = agree = strongly agree
1. I am satisfied that I am adequately informed about the issues important to my decision.
2. The decision I made was the best decision possible for me personally. 3. I am satisfied that my decision was consistent with my personal values. 4. I expect to successfully carry out (or continue to carry out) the decision I made. 5. I am satisfied that this was my decision to make. 6. I am satisfied with my decision.
SOCIETY FOR MEDICAL DECISION MAKING
Call for Nominations The Nominations Committee is soliciting nominations for Society for Medical Decision Making officers and trustees. The positions to be elected for 1996-1997 are: President-elect Vice President-elect Secretary-Treasurer-elect Trustee (3) All trustees serve two year terms of office. We urge you to submit the names of SMDM members whom you believe would serve the Society well. Self-nominations also are encouraged. All submitted names will be considered by the Nominations Committee. At least two nominees will be selected for each position to be elected. Upon approval of the slate by the Board of Trustees, the list of nominees will be mailed to all SMDM members. Additional nominees then will be accepted by petition, as described by the Society’s regulations. Please submit your nominations to Randall D. Cebul, Nominations Committee Chair, prior to February 15, 1996, or contact him if you have any questions regarding the nomination or election process at the address and phone number below: Randall D. Cebul, MD 2.20 A Rammelkamp Building MetroHealth Medical Center 2500 MetroHealth Drive Cleveland, OH 44109 USA Telephone: 216-778-3902; Fax: 216-778-394.5; E-mail:
[email protected]
