Decisional Conflict Scale Scores Research Articles

Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study.

Because multiple management options exist for clinical T1 renal masses, patients may experience a state of uncertainty about the course of action to pursue (ie, decisional conflict). To better support patients, we examined patient, clinical, and decision-making factors associated with decisional conflict among patients newly diagnosed with clinical T1 renal masses suspicious for kidney cancer. From a prospective clinical trial, participants completed the Decisional Conflict Scale (DCS), scored 0 to 100 with < 25 associated with implementing decisions, at 2 time points during the initial decision-making period. The trial further characterized patient demographics, health status, tumor burden, and patient-centered communication, while a subcohort completed additional questionnaires on decision-making. Associations of patient, clinical, and decision-making factors with DCS scores were evaluated using generalized estimating equations to account for repeated measures per patient. Of 274 enrollees, 250 completed a DCS survey; 74% had masses ≤ 4 cm in size, while 11% had high-complexity tumors. Model-based estimated mean DCS score across both time points was 17.6 (95% CI 16.0-19.3), though 50% reported a DCS score ≥ 25 at least once. On multivariable analysis, DCS scores increased with age (+2.64, 95% CI 1.04-4.23), high- vs low-complexity tumors (+6.50, 95% CI 0.35-12.65), and cystic vs solid masses (+9.78, 95% CI 5.27-14.28). Among decision-making factors, DCS scores decreased with higher self-efficacy (-3.31, 95% CI -5.77 to -0.86]) and information-seeking behavior (-4.44, 95% CI -7.32 to -1.56). DCS scores decreased with higher patient-centered communication scores (-8.89, 95% CI -11.85 to -5.94). In addition to patient and clinical factors, decision-making factors and patient-centered communication relate with decisional conflict, highlighting potential avenues to better support patient decision-making for clinical T1 renal masses.

Abstract PO3-11-11: Reproductive concerns of Japanese young women with breast cancer: a longitudinal study

Abstract Background: Treatment-related infertility is one of the major concerns of young women with breast cancer. We explored the longitudinal change and factors associated with reproductive concerns of Japanese young women in a prospective cohort study. Method: Women under the age of forty with newly diagnosed, histologically confirmed, operable breast cancer were recruited to “Hope for YBC Project” (UMIN000034481). The participants were asked to respond to anonymous self-written questionnaire regarding reproductive concern, anxiety and depression, perception of motherhood and socio-economic status at baseline and 6M. Result: Among 215 participants who were enrolled in the study, the mean age of 143 participants who responded to both the questionnaire at baseline and 6M was 35.7 (range 25-39): 78 (54.5%) had a university degree or higher, 104 (72.7%) had a partner, 65 (45.5%) had more than one child, and 84 (58.8%) had a household income more than 5 million yen. 57 (39.9%) had desire for having a baby, 37 (25.9%) were unsure and 43 (33.6%) were not interested. Among 143, 33 (23%) attempted fertility preservation. Baseline score of Reproductive Concerns After Cancer scale (RCAC) had weak correlation with the total scores of Hospital Anxiety and Depression Scale (HADS) (r=.397, p&amp;lt; .001) and Decision Conflict Scale (DCS) (r=.365, p&amp;lt; .001), respectively. Perceived “sufficient explanation of the risk of recurrence” and “sufficient explanation of the necessity and benefit of pharmacotherapy” were significantly associated with reduced DCS score at baseline (p&amp;lt; 0.001). The desire for having a baby changed in 15 women (10.5%) at 6M. Although both DCS and HADS significantly lowered at 6M, there was no difference between RCAC score at baseline and at 6M. RCAC score at 6M had correlation with RCAC(r=.793, p&amp;lt; .001), DCS(r=.439, p&amp;lt; .001), and HADS (r=.401, p&amp;lt; .001) scores at baseline. RCAC score at 6M was also associated with younger age (r=.311), non-existence of partner (p=.001), non-existence of child (p=.014), desire for having a baby (p&amp;lt; .001) at baseline, attempt of fertility preservation (p=.025) and not receiving endocrine treatment (p=.047). Conclusion: Reproductive concerns of young women remained throughout the treatment, and concerns at later treatment phase were associated with decision conflict and anxiety at diagnosis. These results shows that young women, especially those who have higher risk of having reproductive concern, need psychological and decision support at diagnosis, including thorough explanation of risk of recurrence and benefit of systemic treatment from oncologists. Citation Format: Chie Watanabe, Hiroko Bando, Akemi Kataoka, Mai Okazaki, Tadahiko Shien, Eriko Tokunaga, Takashi Kuwayama, Chikako Shimizu. Reproductive concerns of Japanese young women with breast cancer: a longitudinal study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-11.

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

Shared Decision-Making in Cardiovascular Risk Factor Management

The effect of shared decision-making (SDM) and the extent of its use in interventions to improve cardiovascular risk remain unclear. To assess the extent to which SDM is used in interventions aimed to enhance the management of cardiovascular risk factors and to explore the association of SDM with decisional outcomes, cardiovascular risk factors, and health behaviors. For this systematic review and meta-analysis, a literature search was conducted in the Medline, CINAHL, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov databases for articles published from inception to June 24, 2022, without language restrictions. Randomized clinical trials (RCTs) comparing SDM-based interventions with standard of care for cardiovascular risk factor management were included. The systematic search resulted in 9365 references. Duplicates were removed, and 2 independent reviewers screened the trials (title, abstract, and full text) and extracted data. Data were pooled using a random-effects model. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Decisional outcomes, cardiovascular risk factor outcomes, and health behavioral outcomes. This review included 57 RCTs with 88 578 patients and 1341 clinicians. A total of 59 articles were included, as 2 RCTs were reported twice. Nearly half of the studies (29 [49.2%]) tested interventions that targeted both patients and clinicians, and an equal number (29 [49.2%]) exclusively focused on patients. More than half (32 [54.2%]) focused on diabetes management, and one-quarter focused on multiple cardiovascular risk factors (14 [23.7%]). Most studies (35 [59.3%]) assessed cardiovascular risk factors and health behaviors as well as decisional outcomes. The quality of studies reviewed was low to fair. The SDM intervention was associated with a decrease of 4.21 points (95% CI, -8.21 to -0.21) in Decisional Conflict Scale scores (9 trials; I2 = 85.6%) and a decrease of 0.20% (95% CI, -0.39% to -0.01%) in hemoglobin A1c (HbA1c) levels (18 trials; I2 = 84.2%). In this systematic review and meta-analysis of the current state of research on SDM interventions for cardiovascular risk management, there was a slight reduction in decisional conflict and an improvement in HbA1c levels with substantial heterogeneity. High-quality studies are needed to inform the use of SDM to improve cardiovascular risk management.

Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults.

Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31-.37, p < .001), and ACP engagement (r's = -.41 to -.37, p < .001) indicated convergent validity. A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.

Age and race/ethnicity differences in decisional conflict in women diagnosed with ductal carcinoma in situ

PurposeWomen diagnosed with ductal carcinoma in situ (DCIS) face confusion and uncertainty about treatment options. The objective of this study was to determine whether there are differences in decisional conflict about treatment by age and race/ethnicity.MethodsA cross-sectional survey was conducted of women (age ≥ 18) diagnosed with DCIS enrolled at Kaiser Permanente of Southern California. The Decisional Conflict Scale (DCS) measured personal perceptions of decision uncertainty, values clarity, and effective decision-making. We used a multivariable regression to study whether age, race, and ethnicity were associated with patient-reported DCS.Results45% (N = 1395) of women who received the online survey, participated. The mean age was 56 (± 9.6) years, the majority were white. Compared to women younger than 50, women aged 60–69 reported lower overall DCS scores (-5.4; 95% CI -1.5 to -9.3). Women > 70 had lower values clarity scores (-9.0; 95% CI -2.8 to -15.2) about their treatment compared to women aged 50–59 and 60–69 (-7.1; 95% CI -2.9 to -11.3 and − 7.2; 95% CI -2.9 to -11.5) and likewise, lower effective decision-making scores (-5.4; 95% CI -1.7 to -9.2 and − 5.2; 95% CI -1.4 to -9.0) compared to women < 50. Compared to whites, blacks reported lower decision conflict (-4.4; 95% CI 0.04 to -8.8) and lower informed decision (-5.2; 95% CI -0.18 to -10.3) about DCIS treatment.ConclusionYounger women reported higher decisional conflict about DCIS treatment, compared to older women (> 70). Age based tailored discussions about treatment options, health education, and supportive decision-making interventions/tools may reduce decision conflict in future DCIS patients.Trade registrationThe IRB number is 10678.

A video-based decision aid improved knowledge and decreased decisional conflict for asymptomatic persistent endodontic lesions.

This prospective cohort study aimed to (i) evaluate patients' treatment decisions, decisional conflict and knowledge levels before and after use of a video-based decision aid (DA) on asymptomatic persistent endodontic lesions (APEL) and to (ii) elicit important decision factors for patients in the decision-making process. A video DA modelled after the International Patient Decision Aids Standards (IPDAS) was designed. The video was pilot-tested, revised and used on 50 patients referred to the graduate endodontic clinic and presenting with an incidental finding of APEL detected on radiographs, with informed consent (DSRB 2020/00133). Recruitment was conducted from June 2020 to November 2021. Patients' treatment decisions and decision-making process were studied. Patients also completed a questionnaire on knowledge gain, decisional conflict and confidence levels. Forty-three patients (48 teeth) out of 50 patients chose long-term monitoring of APEL while 7 patients (7 teeth) decided on endodontic intervention. Median knowledge scores increased from 58.3 (IQR: 41.7, 75.0) to 87.5 (IQR: 75.0, 100.0) (p < .001); median decisional conflict scale (DCS) scores decreased from 25.0 (IQR: 12.5, 34.4) to 3.1 (IQR: 0, 23.8) (p < .001), and 44 (88%) patients were confident or very confident with their treatment decisions. Statistical analyses showed that asymptomatic condition of tooth was the sole decision factor with statistical significance while socioeconomic factors (age, gender, race, education and income levels) showed no significant trend. The majority of patients presenting with APEL in this study chose long-term monitoring over immediate intervention. Using the video-based DA in the decision-making process significantly improved patients' knowledge and decreased their decisional conflict levels.

Abstract 13746: Mental Health and Implantable Cardioverter Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death

Introduction: Black patients with guideline indications for implantable cardioverter defibrillators (ICD) have lower rates of implantation compared to White patients. The Educational Videos to Address Racial Disparities in ICD Therapy Via Innovative Designs (VIVID) trial enrolled self-identified Black individuals with chronic systolic heart failure and studied the impact of a video-based decision-support tool on decisional quality and ICD implantation. Hypothesis: We hypothesized that depressive symptoms are associated with greater decisional conflict and lower rates of ICD implantation among study participants. Methods: Participants were administered the Patient Health Questionnaire-2 (PHQ-2) depression screen; and the 12-Item Short-Form Health Survey, from which we derived the Mental Component Summary-12 (MCS-12). A decisional conflict scale (DCS) adapted from the Ottawa framework for shared decision-making was used to assess decisional conflict associated with the decision for ICD implantation. An analysis of covariance was used to assess differences in DCS scores. Multivariable logistic regression was used to examine the association between mental health scores and ICD implantation at 90 days. Results: Among 306 included participants, 60 (19.6%) reported depressed mood and 142 (46.4%) reported anhedonia. Participants with the lowest MCS-12 scores (poorer mental health) had greater decisional conflict regarding ICD assent compared to those with the highest MCS-12 scores (adjusted mean difference in DCS score = 3.05 [95% CI: 0.32, 5.78]). By 90-day follow-up, 204 participants (66.6%) underwent ICD implantation. There was no significant association between either PHQ-2 score or MCS-12 score and ICD implantation. Conclusions: Depressed mood and anhedonia were prevalent among Black patients considering primary prevention ICD. Poorer mental health did not impact the likelihood of ICD implantation in this population.

Effectiveness of a Decision Aid Plus Standard Care in Surgical Management Among Patients With Early Breast Cancer

Patients with early breast cancer must choose between undergoing breast conservation surgery or mastectomy. This decision is often difficult as there are trade-offs between breast conservation and adverse effects, and women with higher decisional conflict have a harder time choosing the therapy that suits their preferences. To study the impact of a decision aid with a patient preference assessment tool for surgical decision-making on patients' decisional conflict scale (DCS) score. This 3-group randomized clinical trial was conducted between June 2017 and December 2019 at a single high-volume tertiary care cancer center in Mumbai, India. A research questionnaire comprising 16 questions answered on a Likert scale (from 1, strongly agree, to 5, strongly disagree) was used to measure DCS scores and other secondary psychological variables, with higher scores indicating more decisional conflict. The Navya Patient Preference Tool (Navya-PPT) was developed as a survey-based presentation of evidence in an adaptive, conjoint analysis-based module for and trade-offs between cosmesis, adverse effects of radiotherapy, and cost of mandatory radiation following breast-conserving surgery. Adult patients with histologically proven early breast cancer (cT1-2, N0-1) who were eligible for breast-conserving surgery as per clinicoradiological assessment were included. Those who were pregnant or unable to read the research questionnaire or who had bilateral breast cancer were excluded. Data were analyzed from January to June 2020. Patients were randomized 1:1:1 to study groups: standard care including clinical explanation about surgery (control), standard care plus the Navya-PPT provided to the patient alone (solo group), and standard care plus the Navya-PPT provided to the patient and a caregiver (joint group). The primary end point of the study was DCS score. The study was 80% powered with 2-sided α = .01 to detect an effect size of 0.25 measured by Cohen d, F test analysis of variance, and fixed effects. A total of 245 female patients (median [range] age, 48 [23-76] years) were randomized (82 to control, 83 to the solo group, and 80 to the joint group). The median (range) pathological tumor size was 2.5 (0-6) cm. A total of 153 participants (62.4%) had pN0 disease, 185 (75.5%) were hormone receptor positive, 197 (80.4%) were human epidermal growth factor receptor 2 negative, 144 (58.6%) were of middle or lower socioeconomic status, and 114 (46.5%) had an education level lower than a college degree. DCS score was significantly reduced in the solo group compared with control (1.34 vs 1.66, respectively; Cohen d, 0.50; SD, 0.31; P < .001) and the joint group compared with control (1.31 vs 1.66, respectively; Cohen d, 0.54; SD, 0.31; P < .001). The results of this study demonstrated lower decisional conflict as measured by DCS score following use of the online, self-administered Navya-PPT among patients with early breast cancer choosing between breast-conserving surgery vs mastectomy. Clinical Trials Registry of India Identifier: CTRI/2017/11/010480.

Effectiveness of a patient decision aid for patients with superficial basal cell carcinoma: A pre- and post-implementation study

ObjectiveThis study evaluates whether using a patient decision aid (PDA) for patients with superficial basal-cell carcinoma (sBCC) results in a decreased decisional conflict level and increased knowledge. MethodsIn a prospective multicentre study, patient groups were included before and after implementation of a PDA. Decisional conflict levels were compared directly after making the treatment decision, measured once as the mean score on the decisional conflict scale (DCS). Higher scores correspond with higher conflict levels (0−100). Secondary outcomes were knowledge on treatment options, recognizing a BCC, and risk factors for developing a BCC measured on an adapted version of a validated knowledge questionnaire for melanoma patients, and patient satisfaction with the PDA. ResultsData was available for 103 patients in the control-group and 109 in the PDA-group. The mean DCS score in the control-group was 22.78 (SD 14.76) compared to 22.34 (SD 14.54) in the PDA-group; the decrease was non-significant (p = 0.828). The average percentage correct answers on the knowledge questionnaire increased from 76.5% in the control-group to 80.5% in the PDA-group (p = 0.044). According to the majority of patients in the PDA-group (73.7%) the PDA had added value. ConclusionUsing the PDA had no significant effect on decisional conflict levels, but increased overall knowledge on relevant issues concerning sBCC. Practice implicationsThe PDA can be used as an informational tool by patients with sBCC.

Evaluation of a decision aid for early pregnancy loss: A pilot randomized controlled trial in Philadelphia, Pennsylvania

ObjectivesTo evaluate the effect of a decision aid on decisional conflict scale in patients choosing management for early pregnancy loss. Study designWe conducted a pilot randomized control trial to assess the effect of the Healthwise patient decision aid on decisional conflict scale in patients with early pregnancy loss as compared with a control website. Patients 18years and older were eligible if they had an early pregnancy loss between 5 and 12 completed weeks of gestation. Participants completed surveys at baseline, poststudy intervention, after consultation, and 1week postconsultation. Surveys assessed participant scores on the decisional conflict scale (scale 0–100), knowledge, assessment of shared decision-making, satisfaction, and decision regret. Our primary outcome was the poststudy-intervention decisional conflict scale score. ResultsFrom July 2020 through March 2021 we randomized 60 participants. After the intervention, the median decisional conflict scale score for the control group was 10 [0–30] and 0 [0–20] for the intervention group (p = 0.17). When assessing the decisional conflict scale subscales postintervention, the informed subscale for the control group was 16.7 [0–33.3] as opposed to 0 [0] for the patient decision aid group (p = 0.003). Knowledge remained significantly higher in the experimental arm from the postintervention to the 1-week follow-up. We found no differences between groups when assessing our other metrics. ConclusionsUse of a validated decision aid did not result in statistically significant differences in the total decisional conflict scale scores as compared with the control. Participants allocated to the intervention were more informed postintervention and had consistently higher knowledge scores. ImplicationsUse of a validated decision aid prior to early pregnancy loss management consultation did not affect overall decisional conflict but resulted in improved knowledge.

Decisional conflict in American parents regarding newborn circumcision

Decisional conflict surrounding the topic of circumcision in the newborn male is assumed in some parents but has not been quantified or qualified. It is known that parents often base their decision on cultural and social factors and that physician discussions do affect ultimate decision-making. Information on parents' decision-making surrounding newborn circumcision and ways to mitigate conflict or uncertainty around the decision-making process is needed to better counsel them appropriately. To identify the presence or absence of decisional conflict in parents-to-be deciding whether or not to circumcise their child as well as to identify determinants of this conflict to direct future educational measures. Parents presenting to obstetrics clinic as well as contacted by institutional email were recruited using convenience sampling and completed the validated Decisional Conflict Scale (DCS). A smaller subset of subjects were recruited via institutional email to complete semi-structured interviews regarding the decision-making process and specifically uncertainty regarding the decision. Descriptive statistics and unpaired t tests were used for analysis of survey data. For interview data, an iterative, grounded theory methodology was used. 173 subjects completed the DCS. 12% of all participants had high decisional conflict. Intuitively, those who had not yet decided whether to circumcise had the highest proportion of high DCS (69%), followed by those who had decided to circumcise (9.3%) and those who had decided not to circumcise (1.7%). 24 subjects were interviewed, and based on their DCS scores and interview responses were classified as low, intermediate and high conflict. Three primary themes emerged delineating the high from low conflict groups. There were notable differences in the feelings of subjects regarding knowledge and feeling informed, the importance of particular values and clarity of the roles of these values in decision-making, and feelings of supported decision-making. These themes were used to create a visual model depicting the individual needs of each decision-maker (Fig.1). This study highlights the need for decision support for parents that is not only information-based but focuses on values clarity and supported decision-making. This study provides a jumping-off point for creation of shared decision-making tools directed at individual needs. The limitations of this study are a single institution design and homogeneous population, so when designing materials, additional unrecognized needs will likely be identified. A small, but real proportion of parents-to-be experience significant uncertainty around the decision to circumcise their newborn boys. Identified needs of parents include feeling informed, feeling supported and clarification of important values related to the problem.

The development and phase 1 evaluation of a Decision Aid for elective egg freezing

BackgroundElective egg freezing decisions are complex. We developed a Decision Aid for elective egg freezing and conducted a phase 1 study to evaluate its acceptability and utility for decision-making.MethodsThe online Decision Aid was developed according to International Patient Decision Aid Standards and evaluated using a pre/post survey design. Twenty-six Australian women aged 18–45 years, interested in receiving elective egg freezing information, proficient in English, and with access to the internet were recruited using social media and university newsletters. Main outcomes were: acceptability of the Decision Aid; feedback on the Decision Aid design and content; concern raised by the Decision Aid, and; utility of the Decision Aid as measured by scores on the Decisional Conflict Scale and on a study-specific scale assessing knowledge about egg freezing and age-related infertility.ResultsMost participants found the Decision Aid acceptable (23/25), balanced (21/26), useful for explaining their options (23/26), and for reaching a decision (18/26). Almost all reported satisfaction with the Decision Aid (25/26) and the level of guidance it provided (25/26). No participant reported serious concerns about the Decision Aid, and most would recommend it to other women considering elective egg freezing (22/26). Median Decisional Conflict Scale score decreased from 65/100 (Interquartile range: 45–80) pre-Decision Aid to 7.5/100 (Interquartile range: 0–37.5) post-Decision Aid review (p < 0.001). Median knowledge score increased from 8.5/14 (Interquartile range: 7–11) pre-Decision Aid to 11/14 (Interquartile range: 10–12) post-Decision Aid review (p = 0.01).ConclusionThis elective egg freezing Decision Aid appears acceptable and useful for decision-making. It improved knowledge, reduced decisional conflict and did not raise serious concerns. The Decision Aid will be further evaluated using a prospective randomised control trial.Study registrationACTRN12618001685202 (retrospectively registered: 12 October 2018).

CE-454029-1 THE IMPACT OF GENDER ON DECISIONAL CONFLICT SURROUNDING IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IMPLANTATION AMONG BLACK PATIENTS AT RISK FOR SUDDEN CARDIAC DEATH

Implantable cardiac defibrillators (ICD) reduce the risk of sudden cardiac death (SCD) in patients with heart failure with reduced ejection fraction (HFrEF). Previous studies have shown that women are less likely to undergo ICD implantation than men. "Videos to Address Racial Disparities in Implantable Cardioverter-Defibrillators Via Innovative Designs (VIVID): A Randomized Clinical Trial" (VIVID) investigated the impact of a video-based decision support tool on the decision for ICD implantation and associated decisional conflict. The overall aim of this study is to analyze the impact of gender on decisional conflict and ICD receipt among Black men and women with HFrEF at risk for SCD. The VIVID trial was conducted from September 2016 to April 2020. Gender and race were self-reported. Black patients were randomized to a video-based decision support tool or usual care. A decisional conflict scale (DCS) adapted from the Ottawa Decision Support Framework was used to assess decisional conflict associated with ICD implantation before and after the intervention. Logistic regression was used to measure differences in ICD implantation within 90 days of study enrollment and the association between decisional conflict and ICD implantation between men and women at 90 days. ANCOVA regression was used to measure differences in DCS between Black men and women and the interaction by intervention group. Among 330 Black patients included in the final analysis, 309 patients (197 men and 112 women) had gender and DCS data available. At 90-day follow-up, 73.9% of women compared with 61.9% of men underwent ICD implantation (adjusted OR (95% CI): 2.07 (1.14, 3.78); p=0.02). There was no significant interaction between gender and intervention for ICD implantation. Among all participants, decisional conflict scores decreased and did not differ by intervention (adjusted mean difference (95% CI): -2.00 (-4.05, 0.05)). Women had a greater mean decrease in DCS scores than men (adjusted mean difference (95% CI): -2.16 (-4.23, -0.09); p=0.04); and there was no significant interaction between gender and intervention in DCS scores (p=0.32). Among Black patients eligible for an ICD, women had less decisional conflict associated with ICD implantation and were more likely to receive an ICD than men. Future research should seek to understand the role of gender on decision-making for an ICD.Tabled 1Table 1. Differences in ICD Implantation within 90 Days.Number of ICD Implants/Total (%)Odds Ratio (95% CI)P-valueIntervention GroupUsual Care71/99 (71.7%)Video-Based Decision Support Tool128/203 (63.1%)1.48 (0.83, 2.63)0.18GenderMen118/192 (61.5%)Women81/110 (73.6%)2.07 (1.14, 3.78)0.02All values are adjusted for patient characteristics including age, educational attainment, income, marital status, work status and pertinent comorbidities including hypertension, hyperlipidemia, diabetes, coronary artery disease and atrial fibrillation. Open table in a new tab

Improving Shared Decision-Making for Women with Parkinson’s Disease (P10-11.010)

<h3>Objective:</h3> Develop and test a decision aid for Parkinson’s Disease (PD) patients considering deep brain stimulation (DBS) surgery, with an emphasis on women’s decisional needs. <h3>Background:</h3> When considering DBS, women are more likely to decline surgery or express fear of complications compared to men. Studies in other surgical procedures have found that women are less informed about surgery as a treatment option, exhibit higher decisional conflict and are more likely to decline procedures, citing the need for more information. <h3>Design/Methods:</h3> Semi-structured interviews were conducted with PD patients who had undergone DBS evaluation. A decision aid was developed based on best evidence from the literature and insights from the interviews and underwent four rounds of alpha testing. In a before-after study design, PD patients considering DBS completed surveys on decisional outcomes, including the primary outcome, the Decisional Conflict Scale (DCS). Surveys were performed at baseline and after usual care over the first year. In the second year, participants will complete surveys at baseline and after exposure to the decision aid. <h3>Results:</h3> In interviews with 16 women and 17 men, women reported overall less support. Informational sources were similar between the genders, although women more often reported seeking out others who had DBS. In the before-after study, 31 participants completed baseline surveys and 16 so far have completed the post-usual care surveys. The mean DCS score was 34.9 (18.3) before usual care and 20.6 (16.6) after usual care. Scores lower than 25 are associated with implementing decisions. On all subscales, women had higher scores, indicating higher decisional conflict, however, these differences did not reach statistical significance on interim analysis. <h3>Conclusions:</h3> We developed a DBS Decision Aid employing a user-centered design to meet the decisional needs of women with Parkinson’s disease. A pilot study is currently underway to test the feasibility, acceptability and effectiveness of the decision aid. <b>Disclosure:</b> Dr. Fullard has received research support from Davis Phinney Foundation. Dr. Fullard has received research support from Michael J. Fox Foundation. Dr. Morris has nothing to disclose. Miss Dafoe has nothing to disclose. Erika Shelton has nothing to disclose. Dr. Kern has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. The institution of Dr. Kern has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. The institution of Dr. Kern has received research support from Boston Scientific. The institution of Dr. Kern has received research support from AbbVie Pharmaceticals. Dr. Kern has received research support from Medtronic. The institution of Dr. Matlock has received research support from National Institutes of Health.

Decision Aid on Orthopedic Virtual Care: Patient Preferences in Orthopedic Hand Clinic.

Introduction: The objectives of this study are to develop a decision aid for orthopedic patients to decide between virtual or in-person care and assess patient preferences for these modalities in hand clinic. Methods: An orthopedic virtual care decision aid was developed alongside orthopedic surgeons and a virtual care expert. Subject participation involved 5 steps: Orientation, Memory, and Concentration Test (OMCT), knowledge pretest, decision aid, postdecision aid questionnaire, and Decisional Conflict Scale (DCS) assessment. Patients presenting to hand clinic were initially provided the OMCT to assess decision-making capacity, with those failing excluded. Subjects were then administered a pretest to assess their understanding of virtual and in-person care. Subsequently, the validated decision aid was provided to patients, after which a postdecision aid questionnaire and DCS assessment were administered. Results: This study enrolled 124 patients. Pre- to postdecision aid knowledge test scores increased by 15.3% (p < 0.0001), and the average patient DCS score was 18.6. After reading the decision aid, 47.6% of patients believed that virtual and in-person care provided similar physician interaction, 46.0% felt little difference in effectiveness between the modalities, and 39.5% had no preference for either. Most patients understood their options (79.8%) and were ready to make a care modality decision (65.4%) following decision aid administration. Conclusion: Significant improvements in knowledge scores, strong DCS scores, and high levels of understanding and decision-making readiness support decision aid validity. Hand patients appear to have no consensus preferences for care modality, emphasizing the need for a decision aid to help determine individual care preferences.

Information and decision support needs: A survey of women interested in receiving planned oocyte cryopreservation information

PurposeIdentifying the information and decision support needs of women interested in receiving planned oocyte cryopreservation (POC) information.MethodsAn online survey of Australian women, aged 18-45, interested in receiving POC information, proficient in English, with internet access. The survey covered POC information sources, information delivery preferences, POC and age-related infertility knowledge (study-specific scale), Decisional Conflict Scale (DCS), and time spent considering POC. Target sample size (n=120) was determined using a precision-based method.ResultsOf 332 participants, 249 (75%) had considered POC, whilst 83 (25%) had not. Over half (54%) had searched for POC information. Fertility clinic websites were predominately used (70%). Most (73%) believed women should receive POC information between ages 19-30 years. Preferred information providers were fertility specialists (85%) and primary care physicians (81%). Other methods rated most useful to deliver POC information were online. Mean knowledge score was 8.9/14 (SD:2.3). For participants who had considered POC, mean DCS score was 57.1/100 (SD:27.2) and 78% had high decisional conflict (score >37.5). In regression, lower DCS scores were associated with every 1-point increase in knowledge score (-2.4; 95% CI [-3.9, -0.8]), consulting an IVF specialist (-17.5; [-28.0, -7.1]), and making a POC decision (-18.4; [-27.5, -9.3]). Median time to decision was 24-months (IQR: 12.0-36.0) (n=53).ConclusionWomen interested in receiving POC information had knowledge gaps, and wanted to be informed about the option by age 30 years from healthcare professionals and online resources. Most women who considered using POC had high decisional conflict indicating a need for decision support.

MP48-18 PATIENT SATISFACTION WITH THE PHYSICIAN RELATIONSHIP IMPACTS THE EFFECTIVENESS OF DECISION AIDS IN MEN WITH PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP48-18 PATIENT SATISFACTION WITH THE PHYSICIAN RELATIONSHIP IMPACTS THE EFFECTIVENESS OF DECISION AIDS IN MEN WITH PROSTATE CANCER Patrick Wilson, Jonathon Bergman, Jefersson Villatoro, Lorna Kwan, Kristen Williams, David Penson, and Christopher Saigal Patrick WilsonPatrick Wilson More articles by this author , Jonathon BergmanJonathon Bergman More articles by this author , Jefersson VillatoroJefersson Villatoro More articles by this author , Lorna KwanLorna Kwan More articles by this author , Kristen WilliamsKristen Williams More articles by this author , David PensonDavid Penson More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We scaled a Decision Aid (DA) for men with prostate cancer in different healthcare settings to learn best practices for implementation across a variety of patient populations. This DA was previously shown to improve decision quality at an academic medical center (AMC). We aimed to understand whether patients who showed persistent decisional conflict exhibited distinct characteristics. METHODS: The DA (“WiserCare”) was issued to men with newly diagnosed prostate cancer at a public hospital and two AMCs prior to a clinic visit. The DA displays personalized clinical outcomes and measures preferences for these outcomes with conjoint analysis. We used the Decisional Conflict Scale (DCS) score to categorize patients as having no difficulty (<25), some difficulty (25-37.5), or severe difficulty (>37.5) with making a decision after using the DA, based on prior data. We measured DCS score, Net Promoter Score (likelihood to recommend the physician), and treatment choice after the visit. We evaluated differences in DCS scores using Chi-squared analysis. A Spanish language version DA was available. RESULTS: 1,961 men were invited to use the DA across three sites, and 1,098 did so. 356 completed the post-visit survey. Overall, DCS scores were excellent (total median 6.3 across sites). However, patients reporting “severe difficulty” had significantly worse Net Promoter Scores for their doctor compared to patients with “no difficulty.” Patients with “severe difficulty” were also more likely to be unsure of their treatment choice. Patient age, language, and disease risk did not have a significant association with difficulty with decision making. CONCLUSIONS: Prostate cancer SDM programs can be scaled successfully in public hospitals serving men of varying languages and SES, with overall preservation of DA effectiveness. Patients with persistent “severe difficulty” making decisions were less satisfied with their physician interactions. They were also more likely to remain undecided regarding treatment choice. Additional qualitative work with this population is needed to understand how the physician-patient relationship impacts SDM and whether DAs can be modified to further support specific patient needs. Source of Funding: Patient Centered Outcomes Research Institute (PCORI) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e662 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Wilson More articles by this author Jonathon Bergman More articles by this author Jefersson Villatoro More articles by this author Lorna Kwan More articles by this author Kristen Williams More articles by this author David Penson More articles by this author Christopher Saigal More articles by this author Expand All Advertisement PDF downloadLoading ...

PD32-10 DECISIONAL CONFLICT AMONG PATIENTS NEWLY DIAGNOSED WITH CLINICAL T1 RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023PD32-10 DECISIONAL CONFLICT AMONG PATIENTS NEWLY DIAGNOSED WITH CLINICAL T1 RENAL MASSES Amir Feinberg, Kathryn Gessner, Shannon Myers, Hillary Heiling, Allison Deal, Sara Wobker, Allison Lazard, Marc Bjurlin, Mathew Raynor, Matthew Nielsen, Angela Smith, Eric Wallen, David Johnson, William Kim, and Hung-Jui Tan Amir FeinbergAmir Feinberg More articles by this author , Kathryn GessnerKathryn Gessner More articles by this author , Shannon MyersShannon Myers More articles by this author , Hillary HeilingHillary Heiling More articles by this author , Allison DealAllison Deal More articles by this author , Sara WobkerSara Wobker More articles by this author , Allison LazardAllison Lazard More articles by this author , Marc BjurlinMarc Bjurlin More articles by this author , Mathew RaynorMathew Raynor More articles by this author , Matthew NielsenMatthew Nielsen More articles by this author , Angela SmithAngela Smith More articles by this author , Eric WallenEric Wallen More articles by this author , David JohnsonDavid Johnson More articles by this author , William KimWilliam Kim More articles by this author , and Hung-Jui TanHung-Jui Tan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increasingly, the management of clinical T1 renal masses has become a complex, preference-sensitive decision due to their favorable prognosis and multitude of management options. However, having multiple options can also generate significant decisional conflict and ultimately regret. Accordingly, we sought to evaluate factors driving decisional conflict among patients with clinical T1 renal masses suspicious for kidney cancer. METHODS: From October 2018–June 2022, we prospectively enrolled patients with new clinical T1 renal masses onto GRADE-SRM, a non-randomized hybrid trial investigating the decision-making experience and cancer genomics. Participants completed surveys on their demographics, health status, and patient-centered communication. Beginning in June 2019, participants also completed surveys on their health status and decision-making traits (e.g., self-efficacy, maximizer-minimizer, autonomy preference, literacy, numeracy). For this analysis, decisional conflict served as the primary outcome as measured by the decisional conflict scale (DCS). We compared DCS score by patient and clinical factors using bivariable linear regression analyses. RESULTS: Overall, 236 of 265 enrollees completed a baseline DCS survey. Mean age was 62.4 years (SD 11.2), 61.4% were male, and 31.3% were non-White. While 74.9% had masses ≤4cm in size, 10.7% had high complexity tumors, 5.9% had bilateral masses, and 6.4% had multifocal masses. Overall, mean DCS score was 16.8 (SD 14.1) though 38.1% had a high DCS score (≥25). DCS scores increased with age (p=0.003). Patients with high complexity (p=0.032), cystic (p=0.043), or multifocal (p=0.037) masses had higher DCS scores compared to their counterparts. DCS scores increased with lower self-efficacy (p<0.001) but did not differ based on maximizer-minimizer tendency or numeracy. Patients with less information-seeking behavior and worse perceived communication experienced more decisional conflict (p<0.001). CONCLUSIONS: Over a third of patients with newly diagnosed clinical T1 renal masses suspicious for kidney cancer experience significant decisional conflict. High scores seemed to be driven by tumor complexity, self-efficacy, information-seeking, and perceived communication, perhaps relating to both the potential risks of treatment and the importance of patient-provider communication. Efforts to improve the decision-making experience will need to focus on the collaborative aspects of shared decision-making. Source of Funding: This work was supported by funding from the National Institutes of Health (UNC Integrated Translational Oncology Program T32-CA244125 to UNC/khg) and UNC Lineberger Comprehensive Cancer Center UNCseq v2 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amir Feinberg More articles by this author Kathryn Gessner More articles by this author Shannon Myers More articles by this author Hillary Heiling More articles by this author Allison Deal More articles by this author Sara Wobker More articles by this author Allison Lazard More articles by this author Marc Bjurlin More articles by this author Mathew Raynor More articles by this author Matthew Nielsen More articles by this author Angela Smith More articles by this author Eric Wallen More articles by this author David Johnson More articles by this author William Kim More articles by this author Hung-Jui Tan More articles by this author Expand All Advertisement PDF downloadLoading ...

Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys.

Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. We sought to identify the health-related decisions and decisional needs of Canadians. Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions.