| Summary: | Background: CMS reimbursement guidelines for implantable cardioverter‐defibrillators (ICDs) include mandated shared decision making (SDM), but without any manner of assessing the quality of decisions made. We developed and tested a scale meant to assess patients' knowledge of and preferences specific to ICDs. Such a tool would assess these constructs in the clinical environment, targeting resources and support for patients considering a primary prevention ICD. Methods: Development of the ICD decision quality (ICD‐DQ) scale included (1) item creation, (2) content validation using surveys of patients (n = 23) and clinicians (n = 31), and (3) examination of validity and reliability using a survey of patients who previously received an ICD (n = 295, response rate = 72%). Results: The final scale consists of 12 knowledge and 8 preference items. With respect to content validity, clinician and patient respondents agreed on the importance of 19 of 24 candidate knowledge items (79%), and 9 of 11 treatment preference items (81%). Knowledge items exhibited moderate internal validity (α = 0.62, 1 factor), strong test‐retest reliability (mean % correct at first administration = 59%, 62% at follow‐up, P >.1) and discriminant validity (59% correct for patients, 93% among cardiologists). Short versions of the ICD‐DQ were developed for clinical settings, the scores from both of which correlated with the long version in this cohort (11‐item (r = 0.90) and a 5‐item (r = 0.75)). Conclusions: : The ICD‐DQ fills a critical gap in measuring the quality of patients' ICD decisions. They may be used to evaluate the effectiveness of patient decision aids or the quality of SDM in clinical practice.
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