Development and Psychometric Evaluation of the Decisional Engagement Scale (DES-10): A Patient-Reported Psychosocial Survey for Quality Cancer Care

In light of recent health care reforms, we have provided an illustrative example of new opportunities available for psychologists to develop patient-reported measures related to health care quality. Patient engagement in health care decision making has been increasingly acknowledged as a vital component of quality cancer care. We developed the 10-item Decisional Engagement Scale (DES-10), a patient-reported measure of engagement in decision making in cancer care that assesses patients' awareness of their diagnosis, sense of empowerment and involvement, and level of information seeking and planning. The National Institutes of Health's ResearchMatch recruitment tool was used to facilitate Internetmediated data collection from 376 patients with cancer. DES-10 scores demonstrated good internal consistency reliability (alpha = .80), and the hypothesized unidimensional factor structure fit the data well. The reliability and factor structure were supported across subgroups based on demographic, socioeconomic, and health characteristics. Higher DES-10 scores were associated with better health-related quality of life (r = .31). In concurrent validity analyses controlling for age, socioeconomic status, and health-related quality of life, higher DES-10 scores were associated with higher scores on quality-of-care indices, including greater awareness of one's treatments, greater preferences for shared decision making, and clearer preferences about end-of-life care. A mini-measure, the DES-3, also performed well psychometrically. In conclusion, DES-10 and DES-3 scores showed evidence of reliability and validity, and these brief patient-reported measures can be used by researchers, clinicians, nonprofits, hospitals, insurers, and policymakers interested in evaluating and improving the quality of cancer care.