CollaboRATE Shared Decision Making Scale
Also known as: Collaborative Therapeutic Engagement Scale
CollaboRATE is a three-item patient-reported outcome measure designed to assess shared decision making (SDM) quality in clinical consultations. Developed by Glyn Elwyn and colleagues in 2013, it measures the degree to which clinicians involve patients in decisions about their care through simple, actionable items that are easy to administer and interpret. The scale has become a standard benchmark for evaluating SDM implementation in healthcare systems.
Read the full method
Sign in with a free account to read this section.
Method map
The neighbourhood of related methods — select a node to explore.
When to use it
CollaboRATE is used to assess shared decision making quality across diverse clinical settings: primary care, specialist consultations, surgical pre-operative discussions, and chronic disease management. It is particularly valuable in quality improvement initiatives, clinician training feedback, and research evaluating SDM implementation. Appropriate for adult patients with sufficient cognitive and literacy capacity to rate on a numerical scale. Not suitable for rapid-fire decision making (e.g., emergencies) or populations unable to provide informed preferences.
Strengths & limitations
- Exceptional brevity: only 3 items, <2 minute administration, reduces response burden and increases real-world compliance.
- Strong psychometric validation: high sensitivity and specificity for detecting SDM quality, validated across multiple clinical populations and languages.
- Actionable results: directly measures what matters (patient involvement in options, values exploration, support for decision), enabling targeted SDM training.
- Clinician feedback tool: provides individual clinician-level data, supporting practice improvement and professional development.
- Health system scalability: low cost of administration and analysis supports widespread implementation in quality measurement programs.
- Limited depth: three items cannot capture all dimensions of SDM (e.g., risk communication, emotional support, follow-up); complementary measures may be needed for comprehensive SDM evaluation.
- Numerical response scale (0-9) may be less accessible than verbal anchors for some patients, particularly older adults or those with limited numeracy.
- Recall bias: patient may have difficulty rating a 30-60 minute consultation accurately from memory immediately afterward.
- Clinician awareness effect: knowledge of measurement may artificially inflate scores if clinicians anticipate the question.
- Does not measure outcomes: measures process only; patient satisfaction, health outcomes, and adherence require separate assessment.
Frequently asked
What is the target top-box score for my organization?
International data suggest <30% of consultations achieve top-box (all three items = 9) without SDM training. Quality improvement targets typically range 50-70%, depending on clinical context and organizational maturity. Specialist services and shared decision-making programs report 60-75% top-box achievement.
Can CollaboRATE be used in emergency or urgent care?
CollaboRATE is not appropriate for true emergencies where decisions cannot be delayed for discussion. In urgent care, it may be used only when clinical circumstances permit a brief decision conversation (e.g., urgent but non-emergent surgical consultation). Time pressure significantly reduces SDM scores.
How do I train clinicians to improve CollaboRATE scores?
Evidence-based SDM training includes: (1) explaining multiple treatment options clearly, (2) explicitly asking patients what matters most to them, (3) checking understanding and supporting the patient's preference. Video feedback with patient responses, role-play practice, and organizational systems (e.g., decision aids) are effective.
Should I use top-box or mean score for reporting?
Top-box (all 3 items = 9) is more common for benchmarking and improvement targets, as it represents optimal SDM. Mean score (0-9) is useful for research and granular tracking of incremental change. Both can be reported; top-box is recommended for public reporting and clinician feedback.
Is CollaboRATE available in languages other than English?
Yes. CollaboRATE has been translated and validated in 20+ languages including Spanish, Dutch, German, French, Chinese, and others. Cross-cultural versions maintain psychometric properties. Check the original Elwyn publication or academic databases for locale-specific versions.
Sources
- Elwyn, G., Barr, P. J., Grande, S. W., Thompson, R., Walsh, T., & Ozanne, E. M. (2013). Developing CollaboRATE: A fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Education and Counseling, 93(1), 102-107. DOI: 10.1016/j.pec.2013.05.009 ↗
How to cite this page
ScholarGate. (2026, June 3). CollaboRATE Shared Decision Making Scale. ScholarGate. https://scholargate.app/en/patient-centered-care/collaboste-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Care Transitions MeasurePatient Centered Care↔ compare
- Control Preferences ScalePatient Centered Care↔ compare
- Decisional Conflict ScalePatient Centered Care↔ compare
- Trust in Physician ScalePatient Centered Care↔ compare