SURE Test for Decisional Conflict Screening
Also known as: SURE Screening Tool, Decisional Conflict Screener
The SURE Test is a four-item screening questionnaire designed to rapidly identify patients experiencing decisional conflict—uncertainty or difficulty in making healthcare decisions. Developed by Annette O'Connor and colleagues, the SURE Test is an abbreviated, practical version of the longer Decisional Conflict Scale (DCS), created to detect patients who may benefit from decision support or additional counselling. It is widely used in clinical and research settings for quick, valid screening.
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
The SURE Test is used at decision points in clinical practice: pre-operative consultations, medication initiation discussions, cancer treatment planning, end-of-life care conversations, and chronic disease management decisions. It is particularly useful in busy primary care, specialty clinics, and emergency settings where rapid assessment of decision readiness is needed. Appropriate for literate adult patients capable of understanding treatment options and making informed preferences.
Strengths & limitations
- Exceptional brevity: 4 items, <1 minute, can be administered and scored in any clinical workflow without significant time burden.
- High sensitivity and specificity: validated against the full Decisional Conflict Scale; strong at detecting when patients need additional decision support.
- Clinically actionable: simple scoring (≤2 vs. ≥3) directly indicates whether intervention (decision aid, counselling, information) is needed.
- Language and cultural accessibility: brief format has been successfully translated and validated in multiple languages and cultural contexts.
- Cost-effective: minimal administration and materials cost; easily integrated into electronic health records for automated scoring and alerts.
- Limited diagnostic depth: four items cannot fully characterize the source or nature of conflict; the full DCS or qualitative assessment is needed to understand why a patient is uncertain.
- Binary decision rules: score ≤2 is threshold for intervention, but intermediate scores (e.g., 2 vs. 3) may not sharply distinguish between patients who truly need support and those who are borderline ready.
- No severity gradation: SURE only screens presence of conflict, not magnitude; does not differentiate mild from severe decisional conflict.
- Assumes informed choice: SURE does not assess whether the patient has received adequate information; conflict may reflect information gaps, not true values uncertainty.
- Not validated for all decisions: most validation in common decisions (surgery, medication); less data in rare or highly complex decisions (e.g., experimental treatment, multi-system conditions).
Frequently asked
What should I do if a patient's SURE score is 2?
A score of 2 meets the threshold (≤2) for decisional conflict. Offer additional support: provide written information on options, review pros and cons, clarify what matters most to the patient, address specific concerns. Offer a decision aid if available. Re-administer SURE after support if needed to confirm improved readiness.
Can SURE predict whether a patient will regret their decision later?
No. SURE screens for immediate decisional conflict but does not predict long-term satisfaction or regret. High SURE scores at the time of decision correlate with better short-term decision satisfaction, but additional factors (life changes, unexpected outcomes, evolving values) affect long-term regret.
How does SURE differ from the full Decisional Conflict Scale?
The Decisional Conflict Scale (DCS-16) is a 16-item instrument that measures conflict across five domains: uncertainty, values clarity, support, informed decision, and effective decision. SURE is a 4-item screener that captures the essence (sure/understand risks/values/support) for rapid detection. Use SURE for point-of-care screening; use full DCS for research or detailed conflict characterization.
Is SURE appropriate for cognitively impaired patients?
SURE may be difficult for patients with significant cognitive impairment, dementia, or delirium due to the abstract nature of the items. For such patients, use simpler yes/no questions asked verbally, have a trusted surrogate present, and consider a formal cognitive assessment before using decision-making measures.
Can SURE be automated in my EHR?
Yes. SURE's four yes/no items are simple to implement as a questionnaire in most EHR systems. Configure automated scoring (≤2 flag) and consider triggering alerts or decision aid recommendations when the threshold is met. Ensure EHR captures the time of administration and response.
Sources
- O'Connor, A. M. (2010). Using the Decisional Conflict Scale to evaluate a decision aid. In A. Edwards & G. Elwyn (Eds.), Shared Decision Making in Health Care (pp. 424-438). Oxford University Press. link ↗
- Légaré, F., Côté, L., Labrecque, M., et al. (2012). Decisional conflict in patients and their physicians: a consensus approach. Social Science & Medicine, 65(11), 2280-2290. link ↗
How to cite this page
ScholarGate. (2026, June 3). SURE Test for Decisional Conflict Screening. ScholarGate. https://scholargate.app/en/patient-centered-care/sure-test-decision-quality
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.
- CollaboRATEPatient Centered Care↔ compare
- Control Preferences ScalePatient Centered Care↔ compare
- Decisional Conflict ScalePatient Centered Care↔ compare
- Patient Enablement InstrumentPatient Centered Care↔ compare