The German version of the Four Habits Coding Scheme - association between physicians' communication and shared decision making skills in the medical encounter

OBJECTIVE: To translate a measure of physicians' communication skills, the Four Habits Coding Scheme (4HCS), into German, to examine its psychometric properties, and to analyze its association with the OPTION Scale, which assesses physicians' shared decision making (SDM) behavior.

METHODS: We performed a secondary data analysis of 67 audio-recorded medical consultations. Reliability, internal consistency, and factorial validity of the translated 4HCS were analyzed. The association with the OPTION Scale was examined using correlation and linear regression.

RESULTS: Testing of reliability revealed intraclass correlation coefficients above .70. Results regarding internal consistency and factorial validity were inconclusive. The correlations between the OPTION score and the four dimensions of the 4HCS were .04 (p=.782), -.14 (p=.303), -.15 (p=.279) and .55 (p<.001), respectively. In multiple regression the four dimensions of the 4HCS explained substantial amount of variation in the OPTION scores (R(2)=.42, P<.001).

CONCLUSION: The measure showed good observer reliability, however further testing is necessary. Due to the strong interrelation of both measures, SDM should be seen in the context of broader communication skills.

PRACTICE IMPLICATIONS: The 4HCS can be used in research and medical education. Further studies are necessary that investigate SDM within the context of communication skills.