Development of the IcanSDM scale to assess primary care clinicians' ability to adopt shared decision-making

Introduction: Implementation of shared decision making (SDM) remains a challenge. To support implementation studies, we sought to develop and validate the IcanSDM scale that assesses clinicians' perceptions of their ability to adopt SDM. Methods: An expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Quebec (Canada) completed the IcanSDM and the Belief about Capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM's internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. We then tested the 8-item IcanSDM with a new sample of 17 clinicians. Results: In the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach's alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46). Discussion: IcanSDM is the only instrument measuring this construct. It could thus help bridge the gap in our ability to understand the determinants of clinicians' SDM behavior intentions and thus help improve SDM implementation impacts and efforts. IcanSDM requires testing with a larger sample to confirm its responsiveness.