Operationalising and Measuring Informed Choice in Healthcare: An Umbrella Review

Abstract

Background: Informed choice is of the highest importance in healthcare. However, confusion and challenges remain towards how it is conceptualised and measured. Purpose: This umbrella review aimed to establish how informed choice is operationalised in healthcare and the characteristics and performance of the most commonly used measurement instruments. Data Sources: Four electronic databases (Ovid MEDLINE, Ovid EMBASE, APA PsycINFO and Cochrane Library) were searched up to 29th January 2024. Reference lists of included studies were hand-searched for further relevant publications. Study Selection: After title and abstract screening of 10,434 articles by one reviewer and 10% screened by a second for consistency, two reviewers independently screened sixty full-text articles for inclusion. Key eligibility criteria included systematic reviews in adult healthcare settings where the aim included an evaluation of measures of informed choice. Sixteen articles were included. Data Extraction: Independently extracted by two reviewers using a standardised template. Data Synthesis: Performed using the summarisation technique with systematic reviews as the main unit of analysis and additional sub-analysis of primary measurement instruments identified. Limitations: Heterogeneous definitions complicate search strategies, and eligibility criteria may limit external validity. The ROBIS appraisal identified many reviews as high-risk of bias, limiting the conclusions drawn. Due to heterogeneity, meta-analysis was not possible, and conclusions were limited to narrative reviews. Conclusions: There remains no consensus on how informed choice should be conceptualised and measured within healthcare. This review attempts to bridge these gaps by presenting available concepts and instruments for clinicians, researchers and policymakers. Future recommendations include achieving consistent definitions of informed choice and related concepts, followed by the use of standardised, validated, multidimensional instruments informed by theory in diverse populations.