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Original article
Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE
Evaluación de la toma de decisiones compartidas en la atención comunitaria de salud mental: validación de CollaboRATE
Carlos De las Cuevasa,b,
Corresponding author
ccuevas@ull.edu.es

Corresponding author: Department of Internal Medicine, Dermatology and Psychiatry, Facultad de Ciencias de la Salud–Sección Medicina, Campus de Ofra s/n, 38071 San Cristóbal de La Laguna, Spain.
, Ingunn Mundalc,d, Moisés Betancorte, Mariela L. Lara-Cabreraf,g,h
a Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Spain
b Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, Spain
c Faculty of Health and Social Sciences, Molde University College, Norway
d Kristiansund Community Mental Health Centre, Division of Mental Health, Møre and Romsdal Hospital Trust, Norway
e Department of Clinical Psychology, Psychobiology, and Methodology, Universidad de La Laguna, Spain
f Department of Research and Development, Division of Mental Health, St Olav’s University Hospital, Norway
g Dept. of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
h Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav’s University Hospital, Norway
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Shared decision-making &#40;SDM&#41; is a collaborative and mutual process in which patients and clinicians address the patients&#8217; values and preferences with clinical evidence &#40;<a class="elsevierStyleCrossRefs" href="#bib0080">Elwyn et al&#46;&#44; 2012&#59; Fisher et al&#46;&#44; 2018</a>&#41;&#46; Both the patient and clinician are involved in all phases to share information and express treatment preferences&#44; henceforth&#44; they come to an agreement and make decisions together &#40;<a class="elsevierStyleCrossRef" href="#bib0230">Shay &#38; Lafata&#44; 2014</a>&#41;&#46; In long term conditions&#44; this model is supported by the positive effects of involving patients in decisions&#44; such as increased satisfaction with received health care&#44; increased agreement with prescribed treatment&#44; and quality of life &#40;<a class="elsevierStyleCrossRef" href="#bib0070">Durand et al&#46;&#44; 2014</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0150">Kew&#44; Malik&#44; Aniruddhan&#44; &#38; Normansell&#44; 2017</a>&#41;&#46; However&#44; the implementation of SDM has been surprisingly hard to achieve in in routine mental health care and has not yet been implemented &#40;<a class="elsevierStyleCrossRef" href="#bib0005">Alguera-Lara&#44; Dowsey&#44; Ride&#44; Kinder&#44; &#38; Castle&#44; 2017</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0240">Slade&#44; 2017</a>&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is increasing evidence that SDM positively impacts health outcomes &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Huang&#44; Plummer&#44; Lam&#44; &#38; Cross&#44; 2020</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0140">Joosten et al&#46;&#44; 2008</a>&#41;&#44; but research on SDM in routine mental health care has a limited extent &#40;<a class="elsevierStyleCrossRefs" href="#bib0200">Rodenburg-Vandenbussche et al&#46;&#44; 2019&#59; Slade&#44; 2017</a>&#41;&#46; In clinical psychology and psychiatric care settings&#44; SDM presents several research-related challenges to overcome an efficacious implementation and adequate assessment&#46; To date&#44; there is no gold standard measurement of SDM in research &#40;<a class="elsevierStyleCrossRef" href="#bib0225">Sepucha &#38; Scholl&#44; 2014</a>&#41;&#46; Even though there are an increasing number of tools to measure patient participation in treatment decisions &#40;<a class="elsevierStyleCrossRef" href="#bib0095">Gartner et al&#46;&#44; 2018</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0170">Norful et al&#46;&#44; 2020</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0180">Phillips&#44; Street&#44; &#38; Haesler&#44; 2016</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0215">Scholl et al&#46;&#44; 2011</a>&#41;&#44; the measures contain many items&#44; and observer-completed tools with coding scheme that may require training of scorers&#46; Implementing the measurement of SDM in mental health clinical practice is also affected by comprehensive questionnaires that may not be practical for completion by patients in many clinical settings &#40;<a class="elsevierStyleCrossRef" href="#bib0180">Phillips et al&#46;&#44; 2016</a>&#41;&#44; and by the reduced measurement quality of the questionnaires &#40;<a class="elsevierStyleCrossRefs" href="#bib0095">Gartner et al&#46;&#44; 2018&#59; Phillips et al&#46;&#44; 2016</a>&#41;&#46; The latter can affect the implementation process because studies from the field of clinical psychiatry are frequently described as busy mental health settings&#44; where the most common perceived barrier is a lack of time &#40;<a class="elsevierStyleCrossRef" href="#bib0120">Huang et al&#46;&#44; 2020</a>&#59; Pieterse&#44; Stiggelbout&#44; &#38; Montori&#44; 2019&#59; <a class="elsevierStyleCrossRef" href="#bib0200">Rodenburg-Vandenbussche et al&#46;&#44; 2019</a>&#41;&#44; followed by the lack of adequate SDM tools &#40;<a class="elsevierStyleCrossRef" href="#bib0145">Kalsi&#44; Ward&#44; Lee&#44; Fulford&#44; &#38; Handa&#44; 2019</a>&#41;&#46; Another challenge regarding the implementation of SDM-measurement in clinical settings is that the most feasible assessment relies on self-reported patient experience measures&#46; As such&#44; extensive measures can be exhausting for patients&#44; restricting their reliability and applicability&#46; Appropriate and short measures are required to improve the implementation of SDM through valid and reliable assessment&#46; However&#44; only few studies have investigated tools to simplify the assessment of SDM in specialized mental health settings&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus&#44; the choice of the most appropriate measure should be based on the instrument&#8217;s content and adequate characteristics&#44; as this will help to avoid burdensome and time-consuming measures&#46; The creator of CollaboRATE&#44; a patient self-reported questionnaire developed in 2013&#44; has proposed that CollaboRATE meets these requisites&#46; The brevity and simplicity of the three-item version of the questionnaire has been emphasized in making it feasible to administer in different clinical settings&#46; The questionnaire makes it easy to measure three core SDM dimensions&#58; &#40;1&#41; the patient&#8217;s perception of how much effort was made to help them to understand their health issue&#59; &#40;2&#41; how much the health professional listened to the patient concerning their health issue&#59; and &#40;3&#41; how much effort was made to include what mattered most to most to the patient in the decision about what to do next&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The CollaboRATE focused on patients&#8217; perceptions of being informed about and being involved in the decision&#8208;making steps&#59; these issues are briefly and clearly encapsulated in the questions&#46; Moreover&#44; it is sufficiently generic to be applicable to all clinical encounters and for all conditions &#40;<a class="elsevierStyleCrossRef" href="#bib0075">Elwyn et al&#46;&#44; 2013</a>&#41;&#44; and it seems well suited for busy mental health settings&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the questionnaire was originally validated in 2013&#44; the evidence of its validity has been increasingly documented among several populations&#46; <a class="elsevierStyleCrossRef" href="#bib0020">Barr et al&#46; &#40;2014&#41;</a> used data from the United States to report that the questionnaire had discriminant validity&#44; concurrent validity&#44; and sensitivity to change&#46; <a class="elsevierStyleCrossRef" href="#bib0090">Forcino et al&#46; &#40;2018&#41;</a> have pilot tested a Spanish translation of the questionnaire for use in the United States among patients attending an internal medicine clinic&#46; Their study provided preliminary evidence of the acceptability for routine administration and documented that the questionnaire was easy to use &#40;<a class="elsevierStyleCrossRef" href="#bib0090">Forcino et al&#46;&#44; 2018</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#bib0025">Bravo&#44; Contreras&#44; Dois&#44; and Villarroel &#40;2018&#41;&#41;</a> have conducted a validation study among women in maternity hospital units and found a one-factor solution for the modified version of the CollaboRate&#46; <a class="elsevierStyleCrossRef" href="#bib0125">Hurley et al&#46; &#40;2019&#41;</a> have compared the CollaboRATE with other extensive measures in a pediatric outpatient setting and found that parents of children aged 1-5 years preferred the CollaboRATE&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A Swedish validation study from 2016 &#40;<span class="elsevierStyleItalic">N</span> &#61; 121&#41; was conducted among adults attending municipal services&#44; supported housing services&#44; and rehabilitation mental health programs &#40;<a class="elsevierStyleCrossRef" href="#bib0205">Rosenberg&#44; Schon&#44; Nyholm&#44; Grim&#44; &#38; Svedberg&#44; 2017</a>&#41;&#46; The study found that a modified version of the CollaboRATE displayed good face and content validity&#44; adequate stability over time&#44; and high internal consistency &#40;<a class="elsevierStyleCrossRef" href="#bib0205">Rosenberg et al&#46;&#44; 2017</a>&#41;&#46; Another recent Swedish study conducted among patients with obstructive sleep apnea &#40;<span class="elsevierStyleItalic">N</span> &#61; 193&#41; reported that the CollaboRATE showed good evidence of validity and reliability to measure SDM in addition to accessible time completion &#40;less than 30 seconds&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib0030">Brostrom&#44; Pakpour&#44; Nilsen&#44; Hedberg&#44; &#38; Ulander&#44; 2019</a>&#41;&#46; A validation study conducted in Argentina among adults &#40;<span class="elsevierStyleItalic">N</span> &#61; 56&#41; receiving treatment in family medicine and primary care centers &#40;<span class="elsevierStyleItalic">N</span> &#61; 30&#41;&#44; and specialists &#40;<span class="elsevierStyleItalic">N</span> &#61; 26&#41; found that the CollaboRATE presented adequate evidences of reliability and criterion validity &#40;<a class="elsevierStyleCrossRef" href="#bib0210">Ruiz Yanzi et al&#46;&#44; 2019</a>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although several studies have reported that the CollaboRATE is an appropriate tool for the assessment of SDM in routine practice&#44; more research is required to further explore the appropriateness of the brief CollaboRATE&#46; There is currently no evidence to support the suitability of the questionnaire for the specialized psychiatric care&#46; Furthermore&#44; the CollaboRATE has not yet been validated in Spain&#46; Therefore&#44; the aim of this study is to assess the psychometric properties of CollaboRATE as a measure of the SDM process among outpatients attending specialized in routine mental health care in Spain&#46; The following main hypotheses were stated&#58; The CollaboRATE would yield a good fit in a one-factor solution and a good internal consistency&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Method</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participants</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study cross-sectional study was conducted at the Canary Islands Community Mental Health Hospital&#46; In the fourth quarter of 2019&#44; 250 consecutive outpatients were invited to participate anonymously in the study&#44; 191 persons accepted&#44; and 23&#46;60&#37; refused to participate&#46; Each day&#44; a total of 15 randomly selected patients were informed about the study&#46; In order to be selected&#44; possible participants needed to match to following inclusion criteria&#58; &#40;a&#41; be identified by the personnel at the outpatient service&#44; as a person receiving treatment at the center&#59; &#40;b&#41; be 18 years or older&#59; &#40;c&#41; fluency in Spanish&#59; and &#40;d&#41; consent to participate&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Instruments</span><p id="par0045" class="elsevierStylePara elsevierViewall">The CollaboRATE measure is a three-item patient self-reported questionnaire developed by <a class="elsevierStyleCrossRef" href="#bib0075">Elwyn et al&#46; &#40;2013&#41;</a> The items assess SDM&#46; Responses to each item range from 0 &#40;<span class="elsevierStyleItalic">no effort was made</span>&#41; to a maximum of 9 &#40;<span class="elsevierStyleItalic">every effort was made</span>&#41; for a total of 27&#44; with a higher score indicating a better patient-reported experience with SDM&#46; CollaboRATE scores are calculated as the proportion of participants who report a score of nine on each of the three CollaboRATE questions&#46; A calculation is also based on the percentage of patients who rated all three CollaboRATE questions&#46; Similarly&#44; it is possible to calculate the mean of the three CollaboRATE scores and the mean of the sum of the three items&#44; with higher scores representing better self-reported experiences with SDM&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Control Preferences Scale &#40;CPS&#41;&#44; developed by <a class="elsevierStyleCrossRef" href="#bib0065">Degner&#44; Sloan&#44; and Venkatesh &#40;1997&#41;&#41;</a>&#44; measures the amount of control that patients want to assume in the process of making decisions about the treatment of their diseases was measured using the CPS &#40;<a class="elsevierStyleCrossRef" href="#bib0065">Degner et al&#46;&#44; 1997</a>&#41;&#46; The card-sorting version of the scale was used in this study&#46; It consists of five cards on a board&#59; each card illustrates a different role in decision-making by means of a cartoon and short descriptive statement&#46; In this study&#44; the patients carried out two assessments&#58; prior to the consultation&#44; the examiner asked the patients to choose their preferred card&#59; after being treated by the mental health professional&#44; the examiner asked them to evaluate their experience using a modified version of the scale &#40;<a class="elsevierStyleCrossRef" href="#bib0055">De Las Cuevas &#38; Pe&#241;ate&#44; 2016</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients with an appointment with a psychiatrist at the hospital were invited to participate&#46; A total of three psychiatrists were working at the center during the data collection period&#46; Some of the patients self-reported that they were receiving treatment from a psychologist as well&#46; The patients were identified by the personnel at the outpatient service&#44; who informed them about the study and explained that those who were interested in participating could contact the researcher at the waiting room&#46; Each day&#44; a total of 15 randomly selected patients were informed about the study&#46; All patients interested in participating in the study received full explanations of the study during their stay in the waiting room before the consultation&#46; Those who consented to participate filled out the CollaboRATE and the CPS questionnaires before and after their consultations&#44; together with a brief sociodemographic survey&#46; The study was carried out in accordance with the code of ethics of the Declaration of Helsinki&#44; and all procedures and consent forms were reviewed and approved by the Ethics Committee of the Canary Islands Health Service&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analyses</span><p id="par0060" class="elsevierStylePara elsevierViewall">The data were analyzed using SPSS version 25 for Macintosh &#40;<a class="elsevierStyleCrossRef" href="#bib0130">IBM&#44; 2017</a>&#41; and using R library psych &#40;<a class="elsevierStyleCrossRefs" href="#bib0190">R Core Team&#44; 2019&#59; Revelle&#44; 2018</a>&#41; with ULLRToolbox by <a class="elsevierStyleCrossRef" href="#bib0110">Hern&#225;ndez and Betancort &#40;2016&#41;</a>&#46; The participants were described with means&#44; standard deviations&#44; frequencies&#44; and percentages&#46; A Goodman and Kruskal&#39;s gamma coefficient was calculated to analyze the relationship between preferred and experienced roles&#46; Mean item scores for each of the three CollaboRATE items and top scores were calculated&#46; Calculations were also made for the proportion of desired and perceived participation in treatment decisions&#46; Internal consistency was calculated using Cronbach&#8217;s &#945;&#44; Guttman&#39;s &#955; and &#969;&#46; Factor analysis was performed using principal component and minimum rank analysis &#40;<a class="elsevierStyleCrossRef" href="#bib0165">Mu&#241;iz &#38; Fonseca-Pedrero&#44; 2019</a>&#41;&#46; The usual level of significance was set to <span class="elsevierStyleItalic">p</span> &#60; &#46;05&#44; and 95&#37; CIs were described where required to measure variability&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> depicts the socio-demographic and clinical characteristics in addition to the preferences and experiences of participants&#44; all according to the CPS&#46; There were more female participants &#40;63&#46;40&#37;&#41;&#44; and the mean age of all participants was 44&#46;90 &#177; 15&#46;30 years&#46; Only a minority of participants had higher education&#58; 27&#46;70&#37; had a university degree&#46; Patients&#8217; diagnoses were available in 92&#37; of the patients and included depressive disorder as the most prevalent &#40;37&#46;70&#37;&#41;&#44; followed by anxiety disorders &#40;34&#46;60&#37;&#41;&#44; schizophrenia &#40;11&#46;50&#37;&#41;&#44; and bipolar disorders &#40;4&#46;70&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Almost half of the patients &#40;<span class="elsevierStyleItalic">n</span> &#61; 87&#44; 45&#46;50&#37;&#41; expressed their preference for the doctor and patient sharing responsibility for the decision about which treatment was best&#44; while 24 &#40;12&#46;60&#37;&#41; preferred to leave all treatment decisions to their doctor&#46; Only three patients &#40;1&#46;60&#37;&#41; preferred to make the final treatment decision themselves&#46; Half of the sample expressed a collaborative attitude &#40;<span class="elsevierStyleItalic">n</span> &#61; 99&#44; 51&#46;80&#37;&#41; and self-reported that they shared responsibility with their doctor for deciding which treatment was the best&#46; Next&#44; 52 persons &#40;28&#46;80&#37;&#41; self-reported that their doctor made the final treatment decision after seriously considering their opinion&#46; Overall concordance between preferred and experienced SDM was only 51&#46;30&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; A total of 51 persons &#40;26&#46;70&#37;&#41; self-reported having a more passive role than preferred&#44; and 42 &#40;22&#37;&#41; self-reported having a role that was more active than they preferred&#46; Goodman and Kruskal&#39;s gamma coefficient&#44; which was calculated to analyze the relationship between preferred and experienced roles&#44; exhibited a statistically significance concordance &#40;gamma &#61; &#46;30&#44; <span class="elsevierStyleItalic">p</span> &#61; &#46;003&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The CollaboRATE measure was welcomed by participating patients because it took less than 1 minute to complete and had no missing data&#46; As <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> indicates&#44; the mean item scores for each of the three CollaboRATE items ranged from 7&#46;40 &#177; 2&#46;10 to 7&#46;60 &#177; 2&#46;10&#46; The top scores for each of the three items ranged from 47&#46;10&#37; to 51&#46;80&#37;&#44; and 39&#46;80&#37; of psychiatric outpatients gave the best possible score on the three items&#46; Neither socio-demographic &#40;gender&#44; age&#44; educational level&#41; nor clinical variables &#40;diagnosis and time under psychiatric treatment&#41; played a relevant role in patients&#8217; perception of SDM according to CollaboRATE&#44; since no significant differences were confirmed&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Evidence of validity of internal structure of the CollaboRATE</span><p id="par0080" class="elsevierStylePara elsevierViewall">The performed factor analysis&#44; using principal component analysis&#44; confirmed the unidimensionality of the CollaboRATE measure&#46; The three items perfectly fit a single factor structure that explained 91&#46;10&#37; of variance and factor loadings between 0&#46;94 and &#46;96 &#40;Kaiser-Meyer-Olkin Measure of Sampling Adequacy &#61; &#46;79&#59; Bartlett&#39;s Test of Sphericity&#58; Chi<span class="elsevierStyleSup">2</span> &#61; 578&#44;511&#44; <span class="elsevierStyleItalic">df</span> &#61; 3&#44; <span class="elsevierStyleItalic">p</span> &#60; &#46;001&#59; Principal Component Analysis Communalities&#58; item 1 &#61; &#46;90&#44; item 2 &#61; &#46;93&#44; item 3 &#61; &#46;87&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the correlation matrix of the factor analysis&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">An exploratory factor analysis &#40;EFA&#41; using minimal rank solution was also performed&#46; The solution obtained was compared with and EFA from Pearson correlation matrix following the Ordinary Least Squares &#40;OLS&#41; procedure with solution of minimal residues &#40;Minimal Residual Solution&#41;&#46; Both types of factor solutions had the same weights &#40;CollaboRate01 &#61; &#46;92&#59; CollaboRate02 &#61; &#46;96&#59; CollaboRate03 &#61; &#46;90&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Reliability of the CollaboRATE</span><p id="par0090" class="elsevierStylePara elsevierViewall">The CollaboRATE measure indicated a high internal consistency &#40;&#945; Cronbach &#61; &#46;95&#44; Guttman&#39;s &#955; &#61; &#46;93&#44; and &#969; &#61; &#46;95&#41;&#44; which suggests that the scale measures only one unique concept&#46; The three items registered high correlations with each other &#40;&#46;84 - &#46;89&#41;&#44; indicating that they are measuring the same construct&#46; CollaboRATE items showed high correlations with the total scale score &#40;&#46;88 - &#46;92&#41;&#46; Corrected homogeneity or discrimination indexes obtained where really high &#40;Item 1 &#61; &#46;89&#59; Item 2 &#61; &#46;91&#59; Item 3 &#61; &#46;88&#41;&#46; No item deletion improved Cronbach&#39;s &#945;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Item response theory modelling for evaluating questionnaire item and scale properties was applied&#46; A study of the instrument from a polytomous graduated response model &#40;Graded Response Model&#41; was carried out&#46; A significant model evaluated was reached through an ANOVA model comparing the restricted model vs&#46; unrestricted &#91;AIC 1417&#46;70&#59; BIC 1515&#46;20&#44; Loglik -678&#46;83 LRT 6&#46;86&#44; df 2&#44; <span class="elsevierStyleItalic">p</span> &#60; &#46;032&#93;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> display the test information function showing the goodness of the test when it comes to accurately measuring those of the latent trait for different levels of the attribute&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> depicts the CollaboRATE total score in each self-reported experience according to the CPS&#46; The evidence of convergent validity&#44; a subtype of internal structure validity&#44; indicated that the more passive the experience according to the CPS&#44; the lower the score obtained in the CollaboRATE measure&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study is the first to examine the psychometric properties of the Spanish version of CollaboRATE as a SDM measure in specialized community mental health hospitals&#46; This study yielded relevant results that supported the evidence of the validity of the CollaboRATE&#46; The measure was welcomed in the community psychiatric care&#59; in which a high percentage of outpatients agreed to complete the scale in a short time&#44; and there were no missing data&#46; The one-factor structure and the evidence of convergent validity demonstrated by strong positive correlations between the CollaboRATE and the CPS supported the evidence of validity of the CollaboRATE&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The high internal consistency reported in the present study is similar to those previously reported by <a class="elsevierStyleCrossRef" href="#bib0205">Rosenberg et al&#46; &#40;2017&#41;</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0025">Bravo et al&#46; &#40;2018&#41;</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0125">Hurley et al&#46; &#40;2019&#41;</a>&#44; and <a class="elsevierStyleCrossRef" href="#bib0210">Ruiz Yanzi et al&#46; &#40;2019&#41;</a>&#46; Our results confirmed the unidimensional construct of the questionnaire&#44; and are consistent with the hypothesized factor reported in the original study &#40;<a class="elsevierStyleCrossRef" href="#bib0075">Elwyn et al&#46;&#44; 2013</a>&#41;&#46; However&#44; contrary to another study from Spain suggesting that SDM may differ depending on gender or medical condition &#40;<a class="elsevierStyleCrossRef" href="#bib0035">Calderon et al&#46;&#44; 2018</a>&#41;&#44; in our sample&#44; neither socio-demographic &#40;gender&#44; age&#44; educational level&#41; nor clinical variables &#40;diagnosis and time under psychiatric treatment&#41; played a relevant role in patients&#8217; perception of SDM according to the CollaboRATE&#46; On the other hand&#44; the evidence of convergent validity of the instrument was proven by the significant differences evidenced in the CollaboRATE scores of the different perceptions of involvement&#44; according to the modified CPS&#46; Even though these results support the evidence of validity of the CollaboRATE&#44; they also clearly indicate that SDM is not yet widely implemented across specialized community mental health hospitals in Spain&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Contrary to other studies &#40;<a class="elsevierStyleCrossRef" href="#bib0160">Moran-Sanchez&#44; Gomez-Valles&#44; Bernal-Lopez&#44; &#38; Perez-Carceles&#44; 2019</a>&#41;&#44; more than half of the participants preferred an active role&#46; However&#44; less than half of the participants reported the best score possible on the CollaboRATE&#44; and there is a limited concordance between the preferences and experiences of psychiatric outpatients in SDM&#46; These findings are in line with previous studies suggesting that SDM has yet to be comprehensively implemented in Spain &#40;<a class="elsevierStyleCrossRef" href="#bib0175">Perestelo-Perez et al&#46;&#44; 2011</a>&#41;&#46; This is evidenced by how the Spanish National Health Service still has not incorporated reforms in law that include SDM as a relevant component of mental health care services&#44; or how there still is no standardized practice of interventions to reinforce decisions in routine mental health care &#40;<a class="elsevierStyleCrossRef" href="#bib0175">Perestelo-Perez et al&#46;&#44; 2011</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Furthermore&#44; SDM in mental healthcare and clinical psychological care delivery might require competent professionals with personal beliefs and preferences to negotiate an agreement with a patient who can make decisions and holds personal beliefs and preferences &#40;<a class="elsevierStyleCrossRef" href="#bib0100">Grim&#44; Rosenberg&#44; Svedberg&#44; &#38; Schon&#44; 2016</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0120">Huang et al&#46;&#44; 2020</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0200">Rodenburg-Vandenbussche et al&#46;&#44; 2019</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0235">Simmons&#44; Hetrick&#44; &#38; Jorm&#44; 2010</a>&#41;&#46; Although psychologists and mental health professionals generally support SDM &#40;<a class="elsevierStyleCrossRef" href="#bib0015">Barr&#44; Forcino&#44; Mishra&#44; Blitzer&#44; &#38; Elwyn&#44; 2016</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0045">Chong&#44; Aslani&#44; &#38; Chen&#44; 2013</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0105">Hamann et al&#46;&#44; 2009</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0120">Huang&#44; Plummer&#44; Lam&#44; &#38; Cross&#44; 2020</a>&#41;&#44; they may also consider such approach to be an idealized view that is distant from standard psychiatric practice &#40;<a class="elsevierStyleCrossRef" href="#bib0010">Angell &#38; Bolden&#44; 2015</a>&#41;&#44; as well as condition-dependent or decision topic-dependent &#40;<a class="elsevierStyleCrossRef" href="#bib0220">Seale&#44; Chaplin&#44; Lelliott&#44; &#38; Quirk&#44; 2006</a>&#41;&#44; and partially non-beneficial under certain circumstances &#40;<a class="elsevierStyleCrossRef" href="#bib0105">Hamann et al&#46;&#44; 2009</a>&#41;&#46; On the other hand&#44; patients in mental healthcare settings might demonstrate a variability in their preference for involvement &#40;<a class="elsevierStyleCrossRef" href="#bib0050">De las Cuevas &#38; Pe&#241;ate&#44; 2014</a>&#59; <a class="elsevierStyleCrossRef" href="#bib0060">De las Cuevas&#44; Pe&#241;ate&#44; &#38; de Rivera&#44; 2014</a>&#41;&#44; and when the role preferences are not explored by therapists or clinical psychologists&#44; it is difficult to practice based on concordance with the patient&#8217;s desire of involvement&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The practice of shared decision-making is related to multiple factors and several barriers&#46; The review of the literature has identified time constraints and patients&#8217; decisional incapacity as the main barriers that stand in the way of improving SDM implementation &#40;<a class="elsevierStyleCrossRefs" href="#bib0115">Hofstede et al&#46;&#44; 2013&#59; Huang et al&#46;&#44; 2020&#59; Simmons et al&#46;&#44; 2010</a>&#41;&#46; In mental healthcare&#44; time is precious and scarce&#44; and the lack of such time has been frequently reported as a significant barrier to SDM &#40;<a class="elsevierStyleCrossRefs" href="#bib0120">Huang et al&#46;&#44; 2020&#59; Legare &#38; Thompson-Leduc&#44; 2014&#59; Pieterse et al&#46;&#44; 2019</a>&#41;&#46; However&#44; the lack of time as a barrier is controversial because there are few studies supporting the claim that it takes too much time &#40;<a class="elsevierStyleCrossRefs" href="#bib0120">Huang et al&#46;&#44; 2020&#59; Rodenburg-Vandenbussche et al&#46;&#44; 2019</a>&#41;&#46; Anyway&#44; mental health care systems should place a much higher value on and invest in innovations that create time and realize the possibility of time for patient care &#40;<a class="elsevierStyleCrossRef" href="#bib0155">Legare &#38; Thompson-Leduc&#44; 2014</a>&#41;&#46; Although there are studies that suggest that psychiatric patients&#8217; decisional incapacity might be affected &#40;<a class="elsevierStyleCrossRefs" href="#bib0040">Candia &#38; Barba&#44; 2011&#59; Jeste et al&#46;&#44; 2018</a>&#41;&#44; the majority of the patients are capable of making treatment decisions &#40;<a class="elsevierStyleCrossRefs" href="#bib0040">Candia &#38; Barba&#44; 2011&#59; Huang et al&#46;&#44; 2020</a>&#41;&#46; However&#44; the complexity of SDM is more challenging than the patients&#8217; lack of competency to participate in decisions&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Half of the participants in this study reported that they experienced a lack of effort to help them to understand their health issue and to include in the decision-making process what mattered most for them&#46; These statistics suggest that decision-making is not just about the patient&#8217;s ability or capacity to participate in decisions&#46; The findings suggest that there is the need to reciprocate engagement to facilitate information about health issues&#44; and that effort should be made to involve the patient in treatment planning&#46; As the CollaboRATE is quick to fill out&#44; it is a reliable and valid measure that can be used to routinely monitor&#44; evaluate&#44; and implement the model of SDM in specialized mental health settings&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">This study invited a random sample of patients to participate&#44; and used comparable questionnaires to collect information regarding patient-reported experiences about involvement in treatment decisions&#44; which strengthened the internal structure validity of the CollaboRATE&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although CollaboRATE has high applicability&#44; the study has some limitations that need to be considered&#46; First&#44; the sample comprised psychiatric outpatients who attended at a single community mental health hospital&#46; Second&#44; this study had a high participation rate&#44; and it is possible that a less motivated population could produce a different variability in the preference for their involvement and their experiences with the process of decision-making&#46; In addition&#44; this study had no clinical information of those who did not want to participate in the study&#44; as well as there is a lack of information regarding possible comorbidities or socioeconomic data&#46; These data could have been beneficial to carry on confounding analysis&#46; Finally&#44; due to the cross-sectional design of the study&#44; it was not possible to evaluate the test-retest reliability of the measure&#44; and such evidence of reliability testing should be the subject of future studies&#46; Future research is also needed to investigate that psychometric property&#46; In addition to test-retest reliability&#44; the responsiveness of the questionnaire should be evaluated&#46; It is also important to further assess the impact that comorbidity&#44; received treatment and socio-demographic levels can have on the construct&#46; Future studies could explore how the therapist characteristics affect the construct&#44; and if the CollaboRate is sensitive to different therapists&#8217; characteristics&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion&#44; the present study suggests that the CollaboRATE is a psychometrically robust questionnaire in psychiatric clinical practice&#46; The CollaboRATE measure has proven to be a clinically feasible tool for outpatients to estimate the level of SDM performed by their psychiatrists&#46; It was also found that a significant number of patients are not involved in SDM&#46; The use of this instrument can be crucial in developing knowledge of how best to implement SDM in clinical psychiatric routine care&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Authors contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">The first and the last author contributed to the design of the study&#46; All authors contributed toward drafting and critically revising the paper&#44; gave final approval of the version to be published&#44; and agreed to be accountable for all aspects of the work&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of Interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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              "titulo" => "Statistical analyses"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Evidence of validity of internal structure of the CollaboRATE"
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            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Reliability of the CollaboRATE"
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          "titulo" => "Discussion"
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        7 => array:2 [
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          "titulo" => "Authors contributions"
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          "identificador" => "sec0055"
          "titulo" => "Conflict of Interest"
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        9 => array:2 [
          "identificador" => "xack482295"
          "titulo" => "Acknowledgments"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-03-27"
    "fechaAceptado" => "2020-06-23"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1272909"
          "palabras" => array:4 [
            0 => "CollaboRATE measure"
            1 => "Mental disorders"
            2 => "Shared decision-making"
            3 => "Instrumental study"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1272910"
          "palabras" => array:4 [
            0 => "CollaboRATE"
            1 => "Trastornos mentales"
            2 => "Toma de decisiones compartidas"
            3 => "Estudio instrumental"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background&#47;Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making &#40;SDM&#41; process&#46; The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service&#46; Two hundred and fifty consecutive psychiatric outpatients were invited to participate&#46; Of those&#44; 191 accepted &#40;76&#46;40&#37; of response rate&#41; and completed the CollaboRATE&#44; the Control Preferences Scale &#40;CPS&#41;&#44; and a form with sociodemographic and clinical variables&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Exploratory factor analysis ratified the unidimensionality of the measure&#46; High internal consistency was found &#40;&#945; Cronbach &#61; &#46;95&#44; Guttman&#39;s &#955; &#61; &#46;93&#44; and &#969; &#61; &#46;95&#41;&#46; Strong positive correlations &#40;<span class="elsevierStyleItalic">p</span> &#60; &#46;0001&#41; were found between the CollaboRATE and the CPS&#46; Only 39&#46;80&#37; of respondents gave the best possible score on CollaboRATE&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM&#46; The measure is quick to complete and feasible for use in outpatient mental health care&#46; At present&#44; a significative number of psychiatric outpatients are not involved in SDM&#46; The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background&#47;Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes&#47;Objetivo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CollaboRATE es un autoinforme de tres &#237;tems que permite al paciente valorar su experiencia en la toma de decisiones compartidas &#40;TDC&#41; sobre su tratamiento&#46; El objetivo de este estudio fue evaluar las propiedades psicom&#233;tricas de CollaboRATE en la atenci&#243;n comunitaria de salud mental&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio transversal en una Unidad de Salud Mental del Servicio Canario de la Salud&#46; Doscientos cincuenta pacientes psiqui&#225;tricos ambulatorios consecutivos fueron invitados a participar y 191 aceptaron &#40;76&#44;40&#37;&#41;&#46; Los pacientes completaron el CollaboRATE&#44; la Escala de Preferencias de Control &#40;EPC&#41;&#44; y un formulario con variables sociodemogr&#225;ficas y cl&#237;nicas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis factorial exploratorio ratific&#243; la unidimensionalidad de la medida&#46; Se encontr&#243; una alta consistencia interna &#40;&#945; Cronbach &#61; 0&#44;95&#59; Guttman&#39;s &#955; &#61; 0&#44;93&#59; y &#969; &#61; 0&#44;95&#41;&#46; Se registraron significativas correlaciones positivas &#40;<span class="elsevierStyleItalic">p</span> &#60; 0&#44;0001&#41; entre CollaboRATE y el EPC&#46; Solo el 39&#44;80&#37; de los encuestados dieron la mejor puntuaci&#243;n posible en CollaboRATE&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n en espa&#241;ol de CollaboRATE es una medida fiable y v&#225;lida de TDC&#44; r&#225;pida de completar y factible para su uso en Psiquiatr&#237;a comunitaria&#46; En la actualidad&#44; pocos pacientes psiqui&#225;tricos son involucrados en TDC&#46; CollaboRATE puede ser una herramienta clave para evaluar e implementar la TDC en la atenci&#243;n psiqui&#225;trica ambulatoria&#46;</p></span>"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      ]
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Female&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;63&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age &#40;<span class="elsevierStyleItalic">SD</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;90 &#40;15&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Education level&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;Primary studiesSecondary studiesUniversity degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;23&#46;60&#41;93 &#40;48&#46;70&#41;53 &#40;27&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time as psychiatric patient &#40;months&#41;&#44; mean &#40;<span class="elsevierStyleItalic">SD</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;90 &#40;109&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diagnosis&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;SchizophreniaBipolar disorderDepressive disorderAnxiety disorderPersonality disorder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;11&#46;50&#41;9 &#40;4&#46;70&#41;72 &#40;37&#46;70&#41;66 &#40;34&#46;60&#41;7 &#40;3&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preferred role according to CPS&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;I prefer to make the final treatment decisionI prefer to make the final treatment decision after seriously considering my doctor&#8217;s opinionI prefer that my doctor and I share responsibility for deciding which treatment is bestI prefer that my doctor makes the final treatment decision&#44; but seriously considers my opinionI prefer to leave all treatment decisions to my doctor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;60&#41;19 &#40;9&#46;90&#41;87 &#40;45&#46;50&#41;58 &#40;30&#46;40&#41;24 &#40;12&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Experienced role according to modified CPS&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;I made the final treatment decisionI made the final treatment decision after seriously considering my doctor&#8217;s opinionMy doctor and I shared responsibility for deciding which treatment was bestMy doctor made the final treatment decision&#44; but seriously considered my opinionMy doctor made all treatment decisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;8 &#40;4&#46;20&#41;99 &#40;51&#46;80&#41;55 &#40;28&#46;80&#41;29 &#40;15&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I made the final treatment decision&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">I made the final treatment decision after seriously considering my doctor&#8217;s opinion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">My doctor and I shared responsibility for deciding which treatment was best&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">My doctor made the final treatment decision&#44; but seriously considered my opinion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">My doctor made all treatment decisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer to make the final treatment decision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer to make the final treatment decision after seriously considering my doctor&#8217;s opinion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer that my doctor and I share responsibility for deciding which treatment is best&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer that my doctor makes the final treatment decision&#44; but that they seriously consider my opinion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer to leave all treatment decisions to my doctor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2381249.png"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Crosstabulation of preferences and experiences of shared decision-making according to the CPS&#46;</p>"
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        "etiqueta" => "Table 3"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note&#46; SD</span>&#58; Standard deviation&#59; &#42;Top score&#44; percentage of patients who gave the highest rating possible&#44; which means 9 in every item and 27 in the total score&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CollaboRATE items</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#177; <span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Top score&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">How much effort was made to help you understand your health issues&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;50 &#177; 2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">How much effort was made to listen to the things that matter most to you about your health issues&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;60 &#177; 2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">How much effort was made to include what matters most to you in choosing what to do next&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;40 &#177; 2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CollaboRATE Total Score</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;60 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CollaboRATE scores by item and total score&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Item 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Item 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Item 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;88<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;84<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;88<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;87<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Item 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;84<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;87<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Correlation matrix of exploratory factor analysis of CollaboRATE items&#46;</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note&#46; df</span>&#58; degrees of freedom</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Experienced Control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;<span class="elsevierStyleItalic">SD</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ANOVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I made the final treatment decision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;90 &#177; 2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="middle"><span class="elsevierStyleItalic">F</span> &#61; 111&#46;22<span class="elsevierStyleItalic">df</span> 3&#44; <span class="elsevierStyleItalic">p</span> &#60; &#46;001Eta &#61; &#46;80Eta Squared &#61; &#46;64</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">My doctor and I shared responsibility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;20 &#177; 2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">My doctor made the final treatment decision&#44; but seriously considered my opinion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;30 &#177; 4&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">My doctor made all treatment decisions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;40 &#177; 5&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;60 &#177; 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">ANOVA results of CollaboRATE total score and experiences of control according modified Control Preferences Scale&#46;</p>"
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Article information
ISSN: 16972600
Original language: English
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