Project Summary/Abstract In 2004, the investigators started working to develop measures of “decision quality” and “decision making process” that focus on three elements—the extent to which the patient (1) understands the options and their pros and cons, (2) is meaningfully involved the decision- making process and (3) receives treatment that reflects their goals. Since then, the investigators have produced fourteen decision-specific Decision Quality Instruments and a generic Shared Decision Making (SDM) Process survey to assess these three elements. They recently received endorsement by the National Quality Forum for two performance measures based on these surveys for specific elective surgical decisions. The investigators have amassed a large amount of data on the SDM Process survey in different medical contexts, with different patients, using different modes of administration. However, there has not yet been any systematic examination of existing data to determine the best ways to word items and whether or how the items should vary based on aspects of the clinical decision. Further, the survey has been predominantly used in adults 40 and older, with a major focus on elective surgery decisions. As a result, there is still much work to be done to extend generalizability of the SDM Process survey. In this proposal, the investigators will make significant improvements to the SDM Process survey and will extend its generalizability. We will conduct secondary analyses of existing data from more than 13,000 respondents and compare performance across clinical topics (Aim 1), we will conduct targeted online field tests with 2,000 respondents to evaluate alternative approaches to wording items and to extend generalizability to younger adults and parents making decisions for their children (Aim 2), and we will conduct field tests in clinical settings that have decision support programs in order to establish validity and feasibility (Aim 3). The adapted measure will be practical and feasible to implement, with strong psychometric properties. The measure and associated user guides will provide researchers and clinicians a clear means to evaluate shared decision making and compare different decision support strategies designed to improve the quality of medical decisions.