Decisional Conflict Research Articles

Opportunities to optimize patient experience in the in vitro fertilization (IVF) clinic and the role of genetic counselors.

To understand factors influencing patient satisfaction with genetics education and psychosocial support in an IVF clinic without a genetic counselor (GC), and how the role of a GC may fill gaps in care using a mixed-method cross-sectional study. Previous IVF patients (n = 133) completed a survey assessing satisfaction with genetics education and psychosocial support and decisional conflict about genetic testing. Kruskal-Wallis tests were used to compare satisfaction level to demographic and clinical variables. Spearman's correlation was used to analyze decisional conflict. Focus groups with 12 total participants expanded on themes identified in survey responses. Thematic analysis was performed using interpretive description. Participants reported satisfaction with their genetics education experience (78.9% somewhat or extremely satisfied). Satisfaction with genetics education was associated with satisfaction with information received about genetic testing results (H = 21.3, p < 0.01) and confidence using results in future decisions (H = 9.9, p < 0.01). Participants desired thorough pre-test and post-test counseling regarding genetic testing and directive guidance. Decision conflict about genetic testing was low (mean of 22.3, range 0-100). Satisfaction with genetics education was inversely correlated with decisional conflict (rs = - 0.42, p < 0.05). In-person GC visit scored highest among proposed education methods (mean score of 84.1). Patients felt satisfied with genetics education and psychosocial support provided by clinical providers. Gaps in care included misconceptions regarding genetic testing, a desire for more thorough counseling about genetic testing options, more directive guidance, and increased psychosocial support through external sources such as support groups.

Effects of a structured, family-supported, and patient-centred advance care planning on end-of-life decision making among palliative care patients and their family members: protocol of a randomised controlled trial

BackgroundAdvance care planning (ACP) is a well-recognized quality indicator for palliative care. Despite two decades of effort, previous studies showed that ACP-related documentation and end-of-life discussion rates remain low for palliative care patients. Although ACP is about self-determination and autonomy, studies consistently show the importance of family involvement in adult patient’s medical decision-making. Yet, research on ACP interventions with structured components targeting family member remained limited. The current study aims to evaluate the effectiveness of a structured, family-supported, patient-centred ACP programme for adult palliative care patients and their families.MethodsThis is a 2-arm parallel group randomized controlled trial with follow-ups at 6 and 12 months. One hundred and seventy eligible palliative care patients and their families are planned to be recruited from three hospitals, and randomized to either a structured, family-supported, patient-centred ACP programme (ACP-Family) or usual ACP care (ACP-UC) arm. The ACP-Family intervention consists of 2 sessions. The primary outcome is family’s prediction accuracy of patient’s treatment preferences at 6 months. Secondary outcomes include proportions of new ACP documentations and family-reported perception of whether the patient’s end-of-life (EOL) care preference was respected; patient’s decisional conflict; quality of communication; family’s decision-making confidence; family’s anxiety and depression; and patients’ and family members’ satisfaction of the intervention. Outcomes of the two groups will be compared using regressions and linear mixed-effects models.DiscussionThis study will provide rigorous scientific evidence on the effectiveness of a structured and well-design family-supported, patient-centred ACP programme for adult palliative care patients and their family members in the hospital setting. If the ACP-Family proves to be effective, it will provide a structured and systematic approach to facilitate ACP discussions involving family members. This will respond to local needs and inform international ACP practice.Trial registrationClinicalTrials.gov Identifier: NCT05935540.

Experiences and needs of older patients with stroke in China involved in rehabilitation decision-making: a qualitative study

BackgroundShared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies.MethodsA qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis.ResultsThe key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system.ConclusionsOlder patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary.

Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates.

Surrogates of incapacitated patients in the intensive care unit (ICU) face decisions related to life-sustaining treatments. Decisional conflict is understudied. To compare experiences of ICU surrogates by reported level of decisional conflict related to treatment decisions after a patient's cardiac arrest preceding death. Convergent mixed methods were used. Bereaved surrogates recruited from a single northeastern US academic medical center completed surveys including the low-literacy Decisional Conflict Scale (moderate-to-high cut point >25) and individual interviews about 1 month after the patient's death. Interview data were analyzed by directed and conventional content analysis. Surrogates were stratified by median total survey score, and interview findings were compared by decisional conflict level. Of 16 surrogates, 7 reported some decisional conflict (median survey score, 0; range, 0-25). About two-thirds decided to withdraw treatments. Three themes emerged from interviews: 2 reflecting decision-making experiences ("the ultimate act"; "the legacy of clinician communication") and 1 reflecting bereavement experiences ("I wish there was a handbook"). Surrogates reporting decisional conflict included those who first pursued but later withdrew treatments after a patient's in-hospital cardiac arrest. Surrogates with decisional conflict described suboptimal support, poor medical understanding, and lack of clarity about patients' treatment preferences. These findings provide insight into bereaved ICU surrogates' experiences. The low overall survey scores may reflect retrospective measurement. Surrogates who pursued treatment were underrepresented. Novel approaches to support bereaved surrogates are warranted.

Commentary to: Parental Hope and Psychological Resilience on Social Support and Decision Conflict in Children with Hypospadias

Commentary to: Parental Hope and Psychological Resilience on Social Support and Decision Conflict in Children with Hypospadias

Mixed-methods systematic review of shared decision-making tools for cancer screening

Abstract Shared decision-making (SDM) tools hold promise for guiding informed choices in cancer screening. However, their effectiveness among underserved people, as well as the specific characteristics of these tools preferred by this group and clinicians, remains unclear. This review aimed to synthesize evidence on the effectiveness of SDM tools for cancer screening and explored the preferences of underserved people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analyses showed that SDM tools for cancer screening are effective in reducing decisional conflict for both the general population and the underserved, and in increasing cancer screening knowledge and intention for underserved people only. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes, measured over a six-month period. Insights from the qualitative findings revealed that underserved people highly preferred SDM tools with relevant information about cancer risk, culturally tailored content, and high accessibility, both during clinical encounters and beyond. Meanwhile, clinicians highly preferred tools that can be easily integrated into medical systems, and can effectively guide SDM, while considering their patients’ values and the limited time for consultation. There is strong evidence on the effectiveness of SDM tools in facilitating informed choice in cancer screening, especially among underserved people. However, evidence on long-term outcomes remains insufficient. Additionally, considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential. Key messages • Shared decision-making tools are effective in increasing screening knowledge and intention among underserved people. • Considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.

Implementation of digital patient decision support tools for Atrial Fibrillation treatment: systematic review

Abstract Background/ Introduction Treating atrial fibrillation (AF) involves complex decisions. Digital patient decision-support tools can facilitate shared decision making by significantly reducing decisional conflict and improving patient knowledge [1,2]. Yet, implementation in clinical practice is lagging [3]. Purpose To systematically review trials of digital patient decision-support tools for AF treatment decisions, focusing on factors influencing their implementation in clinical practice. Methods We conducted a systematic review following Cochrane methods. EMBASE, MEDLINE and Scopus were searched from 2005 to 2023. Eligible randomised controlled trials and quasi-experimental trials that evaluated digital patient decision-support tools for AF treatment decisions were included. Two independent reviewers screened title and abstract, extracted data and assessed risk of bias. The implementation outcomes included a description of when and how the tool was used, as well as its characteristics and user satisfaction. Results Thirteen articles reporting on eleven studies (5 RCTs and 6 quasi-experimental trials) met the inclusion criteria (2,714 participants; mean age 71±4.2 years; 26% women; 92% with non-valvular AF, remaining not reported). Risk of bias was low for 2 studies, moderate for one and high for seven studies. All tools (n=11) focused on anticoagulation choice (1: warfarin vs no warfarin; 1: aspirin vs warfarin; 7: Direct Oral Anticoagulants (DOAC) vs antiplatelet or warfarin; 2: unspecified choice). The tools were used either pre-visit (at home or in the waiting room) or during the consultation (n=5). Tools were delivered using a mobile application (n=4), web-based application (n=5), or a desktop (n=2). Of the eleven tools, 2 could automatically calculate individualized stroke risk using data from electronic health records. Most articles reported favourable user feedback regarding use of the digital patient decision-support tools, such as high perceived usefulness, user-friendliness, and overall satisfaction. No significant difference was found in encounter times between intervention and control arms (2 RCTs). Four tools were publicly available and 3 were implemented in healthcare delivery beyond research. Conclusion Despite demonstrated efficacy in reducing decisional conflict and improving patient knowledge, as well as positive clinician and patient experience, only 3 tools were implemented in clinical practice beyond their trial. Future tools could better leverage digital capabilities to integrate with Electronic Health Records, automate stroke and bleeding risk calculations, and personalise content based on patient values and preferences. Additional robust trials and implementation studies are warranted to understand barriers and enablers to the use of these tools.

Feasibility and Acceptability of a Palliative Care Intervention Among Older or Adults with Advanced CKD and their Caregivers.

In non-nephrology settings, specialty Palliative Care (PC) improves decision-making, patient's quality of life (QoL), advance care planning (ACP), and certain indicators of the quality of end-of-life (EoL) care. This pilot RCT explored the feasibility and acceptability of a PC intervention, CKD-EDU, for older adults ≥75 years with eGFR ≤25 ml/min and their caregivers. Participants randomized to the control group received standard nephrology care and routine kidney therapy (KT) education, while those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss KT decisions and EoL planning. Patients were assessed at baseline, 4-6, 12-14, and 24-26 weeks. Main outcomes included intervention feasibility and acceptability, decision-conflict, and patient QoL. The mediating effects of reduced decision conflict on improved QOL were explored, as were the effects of CKD-EDU on ACP, EoL treatment intensity and 6-month-hospitalization. Statistical analyses encompassed descriptive analyses, adjusted repeated-measure-models, mediation analyses and logistic-regression models. Among the 127 eligible patients screened, 58 (44%) consented: 30 were randomized to CKD-EUD and 28 to the control arm. All patients completed baseline assessments, and 89% completed at least one intervention session (n=26/29), underscoring intervention adherence and feasibility. Similarly, assessments completion rates at 4 (83%, n=45/54) ), 12 (93%, n=42/45), and 24 (95%, n=40/42) weeks were high. The intervention received over 85% acceptability ratings for all questions. Patients exposed to CKD-EDU exhibited significant improvement in decisional conflict scale scores (P = 0.003) at 4-6 weeks and improvements in QoL at 24-26 weeks (P=0.02). Exploratory analyses were not statistically significant in this pilot, but all effect sizes were in the predicted direction. This study demonstrates the feasibility and acceptability of CKD-EDU. A larger scale trial is warranted to assess its effectiveness in improving key outcomes important to patients and families.

Structural equation modeling analysis of factors influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan

ObjectivesTo explore the influencing factors and relationships associated with decisional conflict of dialysis modality in End-stage kidney disease (ESKD) patients.MethodsThis study was a survey-based cross-sectional investigation conducted on 150 ESKD patients in a third-class hospital in Wuhan. The general information questionnaire, decisional conflict scale, Montreal cognitive assessment, frail scale, perceived social support scale, and brief health literacy screen were used for investigation. SPSS 25.0 was used to compare the differences between the decisional and non-decisional conflict groups, and AMOS 23.0 was used to construct a structural equation model to explore the influencing factors.ResultsThe incidence of decisional conflict in 150 ESKD patients was 33.3% (50/150). Binary logistic regression analysis showed that the independent risk factors for decisional conflict of dialysis modality in ESKD patients included monthly household income (OR = 0.184), cognitive function (OR = 7.0), social support (OR = 0.891), health literacy (OR = 0.608), the level of eGFR (OR = 1.488), and the level of cTnI (OR = 9.558). The constructed path analysis model had a good fit (x2/df = 1.499, GFI = 0.957, AGFI = 0.911, NFI = 0.906, CFI = 0.967, RMSEA = 0.055). The path analysis showed that health literacy (0.577) had the greatest impact on the decisional conflict, with a direct effect of 0.480 and an indirect effect of 0.097 through cognitive function and monthly household income. Next was social support, with an effect value of 0.434.ConclusionsIn clinical practice, it is important to enhance the health literacy of patients and their families and to provide advanced education on dialysis plans. Additionally, in managing and planning chronic kidney disease progression and dialysis, it is recommended to regularly and systematically assess cognitive function, particularly before the patient’s cognitive impairment worsens or the severity of the disease progresses. Advanced care planning can be established through collaboration between healthcare professionals and patients to ensure appropriate decision-making and management.Implications for the profession and patient careThis paper finds that the factors that influence and relate to dialysis methods in end-stage renal disease patients help nurses exercise autonomy better, assist patients in reducing their decisional conflict, and improve clinical outcomes.Patient or public contributionPatients received a relevant questionnaire survey, and caregivers assisted in conducting the study.

Efficacy of decision aid delivery modes in prostate cancer screening: umbrella review and network meta-analysis.

To review and compare the efficacy of different delivery modes of decision aids (DAs), including computer-based, print-based, multimedia-based, video-based, and website-based on decision-making outcomes for prostate cancer screening compared to usual care (UC) and among the delivery modes. PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Advanced Search, and Turning Research Into Practice (TRIP) Database were systematically searched from inception to August 2023. The primary outcomes were knowledge level, knowledge scores, participation in shared decision-making (SDM), decisional conflict, and preference for SDM participation. Secondary outcomes were the proportion of subjects who underwent screening (actual screening utilisation) and the proportion of subjects who intended to be screened (intention to undergo screening). Network and pairwise meta-analyses were performed using random-effects models. Seven systematic reviews were included. Network meta-analysis found that multimedia (relative risk [RR] 1.51, 95% confidence interval [CI] 1.02-2.24), print (RR 1.82, 95% CI 1.23-2.69), and website-based (RR 1.99, 95% CI 1.32-3.01) DAs significantly increased participation in SDM compared to the computer-based DA. There was a significant reduction in the actual screening utilisation in the computer DA arm compared to the other delivery modes. No significant differences between all delivery modes were noted on knowledge levels, knowledge scores, decisional conflict, preference for SDM participation, and intention to undergo screening. The highest mean surface under the cumulative ranking curve for all primary outcomes showed that website-based was the most effective delivery mode, followed by print-based DA. The pairwise meta-analysis showed a significant increase in participants' knowledge level, knowledge scores, a reduced intention to undergo screening and actual screening utilisation compared to UC. The findings suggest that different types of DAs have varying levels of effectiveness in increasing knowledge level, knowledge scores, participation in SDM, and influencing screening behaviours. While website-based DA appeared the most effective, employing the print-based DA could be a practical solution in settings with limited resources.

Investigating stress, social support, and decisional conflict dynamics in surrogates of intensive care unit patients with cancer.

The purpose of this study is to examine fluctuations in stress, social support, and decisional conflict among surrogates during the admission and discharge phases of intensive care unit (ICU) patients with cancer. Additionally, this study seeks to identify the factors that influence changes in decisional conflict experienced by these surrogates. This study involved surrogates of ICU patients with cancer. Data were collected within three days of ICU admission and during the discharge phase. The study included 115 surrogates of ICU patients with cancer. Following ICU discharge, the surrogates experienced a significant reduction in mean stress levels (t = - 7.205; p < .001), improved family support (t = 3.748; p < .001), and decreased support from healthcare professionals (t = - 3.286; p = .001). Younger surrogates, high-stress levels in surrogates, and low social support from healthcare professionals were associated with high decisional conflict. Stepwise multiple regression analysis indicated that surrogates' age, changes in stress, and changes in healthcare professionals' support explained 5%, 8%, and 16% of the variation in changes in decisional conflict, respectively. To effectively reduce decisional conflict, particularly during the transition of patients with cancer from the ICU, a robust support system and comprehensive information on the treatment and prognosis of diseases in patients with cancer should be provided to younger surrogates. Healthcare professionals can facilitate family meetings and ensure comprehensive communication of the treatment plan. Practical guidance, social work assistance, timely clarification, and thorough information healthcare professionals provide can effectively mitigate decisional conflicts and enhance decision-making processes.

Decision Support Tool to Improve Decision-Making for HIV Pre-Exposure Prophylaxis (PrEP): Development Process and Alpha Testing.

African, Caribbean, and Black (Black) communities in Canada are disproportionately affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP) is a highly effective option for the prevention of HIV. However, the use of PrEP for HIV prevention among eligible Black clients in Canada remains far below the thresholds necessary to achieve the goal of zero new HIV infections. In a recent study in Toronto, PrEP-eligible Black clients were found to have decisional conflict and unmet decisional needs, which affected the quality of their decision-making process regarding the initiation and adherence to PrEP. There is evidence that decision support tools (DSTs) can improve the quality of a decision, the quality of the decision-making process, the implementation or continuation of the chosen option, and the appropriate use of health services. Despite these benefits, there is currently no DST for PrEP-eligible Black clients being asked to consider PrEP for HIV prevention. Our study aimed to develop a DST to improve PrEP decision-making for Black clients and to evaluate the tool's acceptability and usability. We developed and evaluated the PrEP DST for Black patients using the 7-step process outlined in the Ottawa Decision Support Group Guideline for the development and evaluation of DST. To facilitate the implementation of the Ottawa Decision Support Group guideline, we assembled a multidisciplinary team of primary health care providers, researchers, community members with lived experiences, and digital content designers to serve as the steering committee. First, we assessed patients' and primary health care providers' views on decisional support needs, after which we determined the content, design, and distribution plan for the DST. Subsequently, we conducted evidence synthesis, reviews, and appraisal before developing the PrEP DST prototype. The final tool was reviewed by steering committee members for completeness before acceptability and usability testing with potential Black clients and PrEP providers. The web-based DST yielded 27 pages divided into 6 distinct sections. The six sections include (1) an introduction of the DST, (2) clarify your decision, (3) knowledge, (4) a value clarification exercise, (5) support system, and (6) next steps. Both Black clients and PrEP providers reported ease of task performance, general satisfaction, and usefulness of the tool to support decision-making for Black clients. Feedback on usability centered on the need to add a user guide to increase usability. All feedback was incorporated into the final tool. A PrEP DST for Black clients developed using a systematic process and a multidisciplinary steering committee was acceptable and usable by both Black clients and PrEP providers. Further study (eg, randomized controlled trials) may be needed to evaluate the efficacy of the PrEP DST.

Making decisions about antidepressant use during pregnancy: a qualitative interview study of a sample of women in the United Kingdom.

Background An increasing number of pregnant women now take antidepressants. Many pregnant women experience 'decisional conflict' when deciding whether to take antidepressants, but little is known about the attitudes and experiences influencing these decisions. Aim To explore the attitudes and experiences influencing women's decisions about antenatal antidepressant use. Design and setting A qualitative study using in-depth interviews with a sample of UK women who experienced antenatal depression or took antidepressants antenatally within the preceding three years. Method Recruitment adverts were placed by a perinatal mental health charity and on parenting forums and social media platforms, resulting in a convenience sample. Interview data was coded and analysed with thematic analysis using QSR NVivo. Results Twenty-two women were interviewed; half had taken antidepressants during pregnancy. Most women had concerns about adverse effects and viewed antidepressants as adjunctive to non-pharmacological treatments, which were reported as difficult to access. Some women reported that professional advice was insufficiently detailed. Women described the need to cope with their symptoms, their baby, and existing responsibilities, and related their decisions to their perceived ability to cope. This perception was influenced by physical and emotional challenges relating to pregnancy. Women's decisions were influenced by their previous experiences and by the perceived societal expectations placed on pregnant women. Conclusion Decision-making is a complex and dynamic process, personal to each woman's circumstances. Perceived ability to cope is an important factor in decision-making. Detailed information should be offered to women to support with decision-making in relation to antenatal medication use.

Decision regret analysis in early URSL vs medical expulsive therapy 1 for ureteric calculi ≤ 1cm

BackgroundThe study assesses the decisional regret following Shared Decision-making (SDM) in patients selecting either early ureteroscopic lithotripsy (URSL) or medical expulsive therapy (MET) for ureteric stones ≤ 1 cm, with the aim to evaluate their decisional Conflict, satisfaction, and regret regarding their opted treatment choices.MethodsAdults aged more than 18 years with one stone up to 1 cm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at “treatment completion”. Cambridge Ureteric Stone PROM (CUSP) questionnaire for HRQoL, Decision Regret Scale and the OPTION scale (SDM) were filled at treatment completion.Findings111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1%vs68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients’ travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively).InterpretationAfter SDM, decisional regret is higher in patients opting for MET mainly due protracted treatment duration with increased pain and anxiety during the treatment course and the need for additional procedure for attaining stone clearance and the. Despite higher decisional conflict, a larger proportion of patients opt for early URSL with the aim of avoiding anxiety and achieving early stone clearance.

Changes in Outcomes Expectations During the Cochlear Implant Evaluation Process.

Patient expectations are a critical factor in determining cochlear implant (CI) candidacy. However, minimal data are available on how potential CI recipients develop their expectations and if expectations can be modified by providers. In addition, there is little insight into the resources patients use to inform their decision to undergo implantation. This project aims to assess (1) the role of the CI evaluation (CIE) process on patients' expectations, (2) the extent to which patients' pre-CI outcome expectations can be modified, (3) the information patients use to inform their expectations, and patients' preferences for the discussion/display of potential CI outcomes. Prospective mixed methods study of 32 adult CI patients undergoing CIEs. Outcome measures included: pre-CI Cochlear Implant Quality of Life-35 Profile scores (CIQOL-35 Profile); pre-CIE/post-CIE/day of surgery CIQOL-Expectations scores; post-CIE/day of surgery Decisional Conflict Scale (DCS) scores; and pre-CI aided CNC-word and AzBio sentence scores. Thematic analyses of key informant interviews with 19 potential CI recipients were also performed. In aim 1, CI CIQOL-Expectation domain scores remained essentially unchanged following the CIE when averaged across all participants (d = 0.01 to 0.17). However, changes in expectations were observed for many participants at the individual level. Regarding the second aim, participants with higher pre-CIE expectations showed a decrease in expectations following the CIE for all CIQOL domains except emotional and social (d = -0.27 to -0.77). In contrast, the only significant change in participants with lower expectations was an increase in expectations in the environment score from pre-CIE to the day of surgery (d = 0.76). Expectations remained essentially unchanged or continued to change in the same direction between the post-CIE and the day of surgery, narrowing the gap between participants with higher and lower expectations. Overall, participants demonstrated low overall conflict related to their decision to proceed with cochlear implantation (mean DCS of 11.4 post-CIE and 14.2 at time of surgery out of 100) but DCS scores were higher for participants with lower pre-CIE expectations (d = 0.71). In aim 3, key informant interviews demonstrated no differences between the low- and high expectation cohorts regarding resources used to develop their perception of CI outcomes. Potential CI recipients placed high value in talking with patients who had previously received a CI, and preferred discussing CI functional abilities via clinical vignettes described in the CIQOL Functional Staging System rather than by discussing speech recognition or CIQOL-35 Profile scores. The results of the present study suggest that, although overall expectations averaged across the cohort remained essentially unchanged, individual participants' pre-CI expectations can be modified and there is value in measuring these expectations using the CIQOL-Expectations tool to determine if they are realistic. This information can then be utilized during personalized counseling to present a more accurate representation of likely CI outcomes for each patient. Discussions between potential CI recipients and current CI users may also provide valuable information to inform their expectations. In addition, communicating potential CI benefits using CIQOL functional stages and associated clinical vignettes may result in more realistic patient expectations and support shared decision-making related to CI surgery.

A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol

Background Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person’s life, beliefs, and values. We developed the improving uptake of Fracture Prevention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation. Methods The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics. Discussion The iFraP trial will answer important questions about the effectiveness of the new ‘iFraP’ osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines. Trial registration ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407

The mediating effects of parental hope and psychological resilience on social support and decision conflict in children with hypospadias

IntroductionThe most common congenital genital abnormality of the urinary system in infants is hypospadias; its frequency is rising to 0.33 percent globally. Surgical reconstruction is the most effective treatment for hypospadias. Parents, as surrogate decision-makers for children, frequently experience decision-making conflicts when making decisions. Stress is neither a straightforward stimulus nor a simple response. However, a stressor (stimulus) caused by life events and influenced by numerous intermediate factors including personality, social support, and psychosomatic symptoms or diseases is a multi-factor process of stress response (response) . The surgical decision conflict of parents of children with hypospadias is a type of stress response, and social support may have an effect on parents' hope, psychological resilience, and decision conflict, with hope and psychological resilience serving as mediators between social support and decision conflict. AimTo investigate the structural relationship between parental social support, hope, psychological resilience, and parents decision conflict in children with hypospadias. Study DesignA cross-sectional design was used to collect the data of 210 parents of children with hypospadias from Department of Urology, Shenzhen Children's Hospital from April 2022 to March 2023. ResultsSocial support indirectly affects decision conflict through hope and psychological resilience, with a total effect of -0.224 (P<0.05), DiscussionDecision conflicts and regret can be reduced if medical professionals provide adequate and clear information, decision assistance, and meet support requirements during the decision-making process. Improving the level of psychological resilience, hope, and social support among parents of children with hypospadias is a crucial strategy for reducing the level of decision conflict they experience. In the process of making surgical decisions for children with hypospadias, the more sufficient social support from relatives, friends, and medical staff can stimulate their hope, boost their belief in the success of surgery, and the greater their psychological resilience, the more effectively decision conflict can be reduced. Some potential limitations of this study should be considered. Firstly, this study was a cross-sectional survey design. It may have some limitations in providing causal relationships between selected variables. Second, the survey investigated only one hospital, which reduces the generalizability of the findings. ConclusionThe data support the proposed model and confirm the structural relationship among the four study variables. This study provides new information on the mediating role of hope and psychological resilience between social support and decision-making conflict.

Association between genetic information provision and decisional conflict in patients with cancer.

227 Background: The decisional conflict scale (DCS) measures personal perception of uncertainty when facing a decision. In patients with cancer, decision conflict is likely when considering uncertainty in oncologic systemic treatment outcomes. Cancer genomic information can introduce more uncertainty and complexity in care. This study aims to evaluate patients’ DCS score pre or post discussing next generation sequencing (NGS) results with a medical oncologist, and assess factors that correlate with high decision conflict. Methods: Patients diagnosed with incurable/metastatic cancer who underwent molecular characterization with tissue+/- liquid NGS testing were enrolled. Survey instruments included the validated DCS (five subscales: informed, values clarity, support, uncertainty, effective decision), and EQ-5D-5L. DCS was administered pre or post medical oncology consultation that included review of tissue +/- liquid NGS results and treatment options. Higher DCS score correlates with higher perception of uncertainty. Descriptive statistics were used to assess clinical and demographic risk factors. Multivariable logistic regression analysis estimated the correlation between high DCS and clinical factors. Results: 335 DCS surveys were completed by 227 patients: 188 before and 147 after discussing tissue+/- liquid NGS results with a medical oncologist. Baseline characteristics: 56% female, median age 65, ECOG 0-1 58%, median EQ5D VAS score 68, GI/lung/gyne/breast/other 42/32/10/5/11%, white/Asian/other/unknown 66/12/5/17%. Tier 1 variants were identified in 35% of patients. Patients reported decreased decision conflict after consultation. Multivariable logistic regression analysis including sex, age, race and tumor group did not predict for high DCS pre-consultation. MVA post NGS results that also included Tier 1 variants (present / absent) did not predict for high DSC post consultation. Conclusions: Communication regarding genomic-based tumor assessment can positively support patients in decision conflict, and improve their confidence in their treatment choice, regardless of the findings of the report. Low DCS after consultation supports the goal of shared decision making for cancer treatment. Clinical trial information: NCT05057234 . DCS subscale Pre-consultation Post-consultation p value Informed 49.3 37.5 &lt;0.001 Values clarity 45.3 35.5 &lt;0.001 Support 34.4 28.2 0.005 Uncertainty 46.8 36.1 &lt;0.001 Effective decision 40.0 31.4 &lt;0.001 TOTAL 42.9 33.6 &lt;0.001

Effect of Motivational Intervention on Acceptance, Health Literacy and Decisional Conflict Regarding Post-Placental IUD among Pregnant Women

Effect of Motivational Intervention on Acceptance, Health Literacy and Decisional Conflict Regarding Post-Placental IUD among Pregnant Women

Cluster randomized pilot of the Best Case/Worst Case-Geriatric Oncology (BC/WC-GeriOnc) communication tool for older adults with cancer.

226 Background: BC/WC-GeriOnc is a conversation framework and graphic aid that supports shared decision making (SDM) between oncologists and older adults with cancer. Oncologists are trained to use scenario planning to discuss treatment options by describing the range of plausible outcomes—including an individualized most-likely case—and to make a patient preference-aligned recommendation. Methods: To compare BC/WC-GeriOnc vs enhanced usual care (EUC; usual care plus geriatric assessment), we enrolled 7 medical oncologists from a Comprehensive Cancer Center, Veterans Affairs clinic, and safety-net hospital. For each oncologist, we first enrolled 2 EUC patients age ≥65 with any stage solid tumor and recorded decision-making discussions. Oncologists were then randomized 1:1 to BC/WC-GeriOnc training vs EUC. We enrolled up to 5 additional patients per oncologist and recorded discussions. Patients were followed for 2 months with surveys and a one-on-one semi-structured interview. Primary outcomes were feasibility of patient recruitment/retention and oncologist-reported feasibility of using BC/WC-GeriOnc (surveys and interview). Secondary outcomes were intervention adherence, fidelity, and oncologist- and patient-reported acceptability and appropriateness. Exploratory outcomes included patient-reported SDM, decisional conflict, and regret. We used descriptive statistics to summarize results. Results: Among 43 patients (15 intervention, 28 EUC), median age was 71 (IQR 68-77). The most common cancers were gastrointestinal (30%), thoracic (26%), breast (19%), and genitourinary (19%). Treatment was palliative in 58%. Patient recruitment rate was 70%. Retention was 98% post decision, 93% at 1 month, 86% at 2 months, and 73% at the patient interview. Mean oncologist feasibility, acceptability, and appropriateness scores were each 4 out of 5, which corresponds to “agree.” Intervention adherence (93%) and fidelity were high (median score 14 out of 15, IQR 11-15). Oncologists reported that the tool improved communication: “It really kind of crystalized things in my mind and helped me communicate better.” Patients found that the tool clarified options, encouraged deliberation, and supported oncologist communication. Mean patient-reported SDM score was 85.6 (out of 100-best, SD 15) in the intervention arm and 77.5 (SD 22) in EUC (Cohen’s d 0.43). In the intervention arm, 15% of patients had high decisional conflict after the decision was made (score &gt;37.5/100) versus 21% in EUC. At 2 months, 22% in the intervention arm had high decision regret (score &gt;25/100) compared with 45% in EUC. Conclusions: It was feasible and acceptable for oncologists to use BC/WC-GeriOnc to support SDM for older adults with cancer. Promising patient-reported SDM and decisional outcomes support testing the tool in a full-scale efficacy trial. Clinical trial information: NCT05374304 .