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Involvement in Decision-Making and Treatment Options

​This measure describes whether patients and family/friends were involved in care decisions. Results show the percentage of patients who responded most favourably in the CPES-IC survey.

Higher is better. The higher the Top Box result, the higher the number of patients who responded favourably.

Data updated:
Data availability: to (fiscal years)
Geographic coverage
New Brunswick, Nova Scotia, Ontario, Manitoba, Alberta
Reporting level
National, Province/Territory, Region, Facility
Calculation

Involvement in Decision-Making and Treatment Options is a composite PREM based on 2 questions in the CPES-IC. Please see Canadian Patient Experiences Survey — Inpatient Care: Patient-Reported Experience Measures (PDF) for further detail. 

This measure is calculated as a Top Box result, which is the percentage of survey respondents who chose the most positive response (e.g., “Always”). For this composite measure, the Top Box result is calculated by averaging the Top Box results for each corresponding question. 

Each question’s Top Box result is calculated as follows:
(Number of patients who chose the most positive response for a question in the CPES-IC survey) ÷ (Total number of respondents for that question)

Denominator

Patients age 18 and older who responded to questions regarding involvement in decision-making and treatment options in the CPES-IC survey (questions 35 and 36)

Numerator

A subset of the denominator that represents patients age 18 and older who chose the most positive responses to the questions about involvement in decision-making and treatment options in the CPES-IC survey (questions 35 and 36)

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Name

Involvement in Decision-Making and Treatment Options

Short/Other Names

Involvement in Decision-Making

Description

The Involvement in Decision-Making and Treatment Options patient-reported experience measure (PREM) looks at one of the key elements of patient experience. It is based on 2 questions from the Canadian Patient Experiences Survey — Inpatient Care (CPES-IC): 

  • Q35. Were you involved as much as you wanted to be in decisions about your care and treatment? 
  • Q36. Were your family or friends involved as much as you wanted in decisions about your care and treatment?

This PREM calculates the percentage of patients who responded favourably to survey questions 35 and 36.
 

Rationale

Public reporting of PREMs amplifies the voice of patients. Results highlight opportunities for care providers and decision-makers to develop improvement initiatives that respond to patient preferences and needs. 

Patient experience measurement and comparison can help address information gaps to improve patient-centred care and facilitate peer-to-peer learning and sharing of best practices.
 

Interpretation

Higher is better. The higher the Top Box result, the higher the number of patients who responded favourably.

HSP Framework Dimension

ϱ system outputs: Person-centred

Available Data Years

to (fiscal years)

Geographic Coverage

  • New Brunswick
  • Nova Scotia
  • Ontario
  • Manitoba
  • Alberta

Reporting Level/Disaggregation

  • National
  • Province/Territory
  • Region
  • Facility
  • Hospital 
  • Peer group

Indicator Results

Web Tool: 

PDF: Accessing Indicator Results on Your ϱ System: In Depth (PDF)

Web Tool: Canadian Patient Experiences Survey: Comparative Results tool

Update Frequency

Every year

Latest Results Update Date

Description

Involvement in Decision-Making and Treatment Options is a composite PREM based on 2 questions in the CPES-IC. Please see Canadian Patient Experiences Survey — Inpatient Care: Patient-Reported Experience Measures (PDF) for further detail. 

This measure is calculated as a Top Box result, which is the percentage of survey respondents who chose the most positive response (e.g., “Always”). For this composite measure, the Top Box result is calculated by averaging the Top Box results for each corresponding question. 

Each question’s Top Box result is calculated as follows:
(Number of patients who chose the most positive response for a question in the CPES-IC survey) ÷ (Total number of respondents for that question)

Type of Measurement

Percentage or proportion

Denominator

Description:

Patients age 18 and older who responded to questions regarding involvement in decision-making and treatment options in the CPES-IC survey (questions 35 and 36)

Inclusions:

  • Admission to an acute care institution (Facility Type Code = 1)
  • Age at admission: 18 and older
  • Sex recorded as male or female

Exclusions:

  • Non-response categories (refusal, don’t know, not stated)
  • Records with invalid health card number
  • Records with missing or invalid discharge date
  • Newborn, stillbirth or cadaveric donor records (Admission Category Code = N, R or S)
  • Records with discharge as death, self sign-out or patient not returning from a pass (Discharge Disposition Code = 61, 62, 65, 66, 67, 72, 73 or 74)
  • Patients receiving care primarily for a psychiatric condition or mental health disorder (ICD-10-CA: F00–F99)
  • Patients who were in an alternate level of care
  • Patients with a substance-use disorder (ICD-10-CA: E24.4, F10, F11, F12, F13, F14, F15, F16, F18, F19, F55, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, Q86.0, T40.0, T40.1, T40.2, T40.3, T40.4, T40.5, T40.6, T40.7, T40.8, T40.9, T42.3, T42.4, T42.6, T42.7, T43.6, T43.8, T43.9, T51, O35.4, O99.3)
  • Patients discharged to another facility such as residential care, group/supportive living or a correctional facility (Discharge Disposition Code = 30, 40 or 90)
  • Patients excluded for sensitive or compassionate reasons with the following diagnoses (ICD-10-CA):
    • Pregnancy with abortive outcome (O00–O08)
    • Threatened abortion (O20.003, O20.009)
    • Complications specific to multiple gestation: delivery of papyraceous fetus, spontaneous abortion of 1+ fetus, selective fetal reduction, intrauterine death, complications specific to multiple gestation, maternal care for known or suspected fetal abnormality and damage (O31.001–O31.801, O35.001–O35.901) 
    • Maternal care for intrauterine death (O36.421–O36.499)
    • Maltreatment syndromes (including sexual, psychological or physical abuse; neglect/abandonment; unspecified maltreatment) (T74.0–T74.9)
    • Intentional self-harm (X60–X84)
    • Assault, cruelty, torture or abuse (including sexual assault) (X85–Y09)
    • Event of undetermined intent (Y10–Y34)
    • Examination and observation following alleged adult rape and seduction (Z04.4)
    • Examination and observation following alleged adult/child sexual and physical abuse (Z04.50, Z04.51) 
    • Outcome of delivery (Z37.100, Z37.101, Z37.300, Z37.301, Z37.400, Z37.401, Z37.600, Z37.601, Z37.610, Z37.611, Z37.620, Z37.621, Z37.630, Z37.631, Z37.680, Z37.681, Z37.690, Z37.691, Z37.700, Z37.701, Z37.710, Z37.711, Z37.720, Z37.721, Z37.730, Z37.731, Z37.780, Z37.781, Z37.790, Z37.791)
    • Palliative care (Z51.5)
  • Patients excluded for sensitive or compassionate reasons with the following diagnosis (CCI):
    • Pregnancy with abortive outcome (5.CA.20, 5.CA.24, 5.CA.88, 5.CA.89, 5.CA.90, 5.CA.93)
  • Patients who have duplicate submissions (determined by submitting province, submitting hospital, health card jurisdiction code and encrypted health card number in the last 12 months)

Numerator

Description:

A subset of the denominator that represents patients age 18 and older who chose the most positive responses to the questions about involvement in decision-making and treatment options in the CPES-IC survey (questions 35 and 36)

Method of Adjustment

To ensure comparability, results have been

  • Sample weighted
  • Non-response weighted
  • Age–sex standardized to the hospital Discharge Abstract Database (DAD) population
  • Adjusted for survey mode (mail, telephone, online)
  • Adjusted for service line (medical, surgical, maternity)

Adjustment Applied

Covariates used in risk adjustment:

Acute Care Patient-Reported Experience Measures — Methodology Notes (PDF)

CPES-IC Mode and Service Line Adjustments — Data Tables (XLSX)

Data Sources

Canadian Patient Experiences Reporting System (CPERS)

Caveats and Limitations

This measure captures the experiences of individuals who were admitted to an acute care hospital.

As CPERS-submitting jurisdictions have different survey cycles, the jurisdictions within each fiscal year (data year) may vary. Some jurisdictions collect annually, while others collect every 3 years. The available fiscal years (data years) for each jurisdiction are as follows:

Nova Scotia: 2017 (partial data coverage)

New Brunswick: 2015 and 2018 (surveys are conducted over a 3-to-4-month period)

Ontario: 2016 to 2021 (partial data coverage)

Manitoba: 2015 to 2021

Alberta: 2017 to 2021 

Data coverage is partial for the following jurisdictions in the most recent data year (2021):

  • Nova Scotia (38%)
  • Ontario (52%)

The frequency of survey collection also varies across hospitals within jurisdictions. The following hospitals collected data up to fiscal year 2020, whereas organizations within their province reported up to 2021:

  • Hôpital Glengarry Memorial Hospital, Ontario
  • Lennox and Addington County General Hospital, Ontario
  • Huron Perth ϱcare Alliance, Ontario 
  • Hamilton ϱ Sciences, Ontario 
     

The following hospitals collected data up to fiscal year 2019, whereas organizations within their province reported up to 2021:

  • Norfolk General Hospital, Ontario
  • North Bay Regional ϱ Centre, Ontario
  • North York General Hospital, Ontario
  • Sunnybrook ϱ Sciences Centre, Ontario
  • Hardisty ϱ Centre, Alberta

To enable comparisons and benchmarking year over year when data isn’t available annually, all respondents from each hospital’s most recent year of data are used to calculate peer, regional, provincial and national averages. Blended averages include data up to a maximum of 3 fiscal years only.

As a result of the 3-year blended average methodology, caution should be taken when comparing Nova Scotia and New Brunswick results with other hospital, peer, regional, provincial and national averages.

Trending Issues

For a trend assessment, at least 3 data years (within the past 10 years) are required. At this time, results for Nova Scotia and New Brunswick will not be reported with trending information. 

Trending results are not available when the most recent data year (2021) is not available. 

Comments

Details about performance assessment, funnel plots, trending and suppression rules are found in the methodology notes.

How to cite:

Canadian Institute for ϱ Information. Involvement in Decision-Making and Treatment Options. Accessed January 4, 2025.