Assessing shared decision-making in clinical practice: a systematic review and meta-analysis of studies using OPTION-12 and OPTION-5.

Abstract

Objectives: Observing Patient Involvement in Decision Making (OPTION)-12 and OPTION-5 assess the extent to which observers score healthcare professionals' (HCPs) involvement of patients in shared decision-making (SDM). We systematically reviewed studies measuring the extent to which HCPs involve patients in the decision-making process using the OPTION instrument.

Design: Informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we updated a previous systematic review and included new studies reporting OPTION-12 or OPTION-5 scores from recordings of real-world clinical encounters, involving patients and HCPs making healthcare-related decisions. Searches were conducted across PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases (2012-2025), supplemented by citation screening and outreach to professional networks. We extracted study characteristics, OPTION version, psychometric data and item-level score details. We also assessed the study quality using the reports of rating procedures and conducted meta-analyses, subgroup analyses using a priori hypotheses and completed meta-regressions.

Results: In total, 174 studies were included, comprising almost 20 000 clinical consultations: 102 studies used only OPTION-12 and 64 used only OPTION-5, while four studies reported using both scales. Mean OPTION-12 and OPTION-5 score for studies unaffected by interventions were 25.1 (95% CI 22.1 to 28.2, k=76, I²=99.71%) and 31.8 (95% CI 26.6 to 37.1, k=42, I²=99.55%), respectively. Subgroup analyses revealed significantly higher scores in studies with postintervention OPTION-scores for both OPTION-12 (38.4 vs 25.1, p<0.001, k=91, I²=99.55%) and OPTION-5 (47.7 vs 31.8, p<0.001, k=65, I²=99.39%). In univariable meta-regression, longer consultation duration and female patient percentage (only for OPTION-12) were associated with higher scores. However, multivariable meta-regression revealed that clinical setting was the sole independent predictor for OPTION-12 (p=0.007), whereas consultation duration remained the primary independent predictor for OPTION-5 (p=0.003).

Conclusions: Since the 2015 previous review, little overall improvement has been observed. This limited progress raises important questions about how we interpret changes in observed SDM. Specifically, it remains unclear what degree of change in OPTION-12 scores reflects a meaningful improvement. Our multivariable findings provide a more nuanced perspective: while consultation duration remains the primary independent predictor for patient involvement when measured with OPTION-5, clinical setting emerges as a more critical independent driver for OPTION-12. These results suggest that the influence of time is not uniform across assessment tools and that structural barriers in different clinical environments must also be addressed to foster SDM effectively.

Prospero registration number: CRD42022332231.