Open Access Research article

The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)

Mike Slade1*, Harriet Jordan1, Eleanor Clarke1, Paul Williams1, Helena Kaliniecka1, Katrin Arnold2, Andrea Fiorillo3, Domenico Giacco3, Mario Luciano3, Anikó Égerházi4, Marietta Nagy4, Malene Krogsgaard Bording5, Helle Østermark Sørensen5, Wulf Rössler6, Wolfram Kawohl6, Bernd Puschner2 and the CEDAR Study Group

Author Affiliations

1 Section for Recovery (Box P029), Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK

2 Department of Psychiatry and Psychotherapy II, Section Process-Outcome Research, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg 89312, Germany

3 Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, Naples 80138, Italy

4 Medical and Health Science Center, Department of Psychiatry, University of Debrecen, Nagyerdei krt. 98, Debrecen 4012, Hungary

5 Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, Aalborg 9000, Denmark

6 Department of General and Social Psychiatry, University of Zurich, Militärstrasse 8, Zurich 8021, Switzerland

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BMC Health Services Research 2014, 14:323  doi:10.1186/1472-6963-14-323

Published: 28 July 2014



The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) – with versions for patients (CDIS-P) and staff (CDIS-S) – for use in mental health services.


An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich.


After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff.


CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at webcite.

Trial registration


Clinical decision-making; Involvement; Satisfaction; Mental health; Psychometric; Translation; Patient reported outcome measure; Recovery