Decisional Conflict Scale Scores Research Articles

MP25-04 IMPACT OF A NOVEL METHOD OF PATIENT PREFERENCE ELICITATION ON DECISION QUALITY IN MEN WITH PROSTATE CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I1 Apr 2016MP25-04 IMPACT OF A NOVEL METHOD OF PATIENT PREFERENCE ELICITATION ON DECISION QUALITY IN MEN WITH PROSTATE CANCER Joseph Shirk, Alan Kaplan, Josemanuel Saucedo, Sylvia Lambrechts, Ely Dahan, Kate Crespi, and Christopher Saigal Joseph ShirkJoseph Shirk More articles by this author , Alan KaplanAlan Kaplan More articles by this author , Josemanuel SaucedoJosemanuel Saucedo More articles by this author , Sylvia LambrechtsSylvia Lambrechts More articles by this author , Ely DahanEly Dahan More articles by this author , Kate CrespiKate Crespi More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.781AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shared decision making can assist men with localized prostate cancer in making informed decisions. The added benefit of patient preference measurement in this setting is not known. We investigated satisfaction and decisional quality in patients who had exposure to a standard decision aid, with and without preference clarification. METHODS We developed a software-based preference assessment method which used conjoint analysis to allow preference measurement. 122 men with incident localized prostate cancer were recruited in the West LA Veterans Affairs Urology Clinic and randomized to a control group that received education with a brochure about prostate cancer treatment only or a treatment group that received preference assessment prior to the clinic visit in addition to the brochure and received a report detailing the strength of their preferences for treatment attributes. The men were then surveyed with instruments measuring elements of decision quality and patient satisfaction with care. RESULTS Baseline knowledge scores were low (average 62%). The average ± SD total score on the Decisional Conflict Scale (DCS) was 2.3 ± 0.9, signifying a moderate level of baseline decisional conflict. There was a significant difference in the pre- to post-consultation change in DCS score between the control and treatment groups in the Perceived Effective Decision Making subscale (p=.003) as well as the total score (p=.023)(Figure). When comparing all interventions to active surveillance and patients unsure about treatment, there was a significant change in patient preference towards surgery in the treatment group when compared to control group (35% pre-consultation to 47% post-consultation in education only group vs 44% pre-consultation to 63% post-consultation in education with conjoint analysis group (p=.043). CONCLUSIONS Individual-level, conjoint analysis-based preference assessment is feasible in the clinic setting. We show that prostate cancer patients who undergo values clarification with conjoint analysis are more certain about their treatment decisions and have decreased levels of conflict when making these decisions. Preference assessment provided benefit above and beyond that achieved with educational content alone in men facing a treatment decision for prostate cancer. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e279-e280 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Shirk More articles by this author Alan Kaplan More articles by this author Josemanuel Saucedo More articles by this author Sylvia Lambrechts More articles by this author Ely Dahan More articles by this author Kate Crespi More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial.

BackgroundMany women with depression experience significant difficulty making a decision about whether or not to use antidepressant medication in pregnancy. Patient decision aids (PDAs) are tools that assist patients in making complex health decisions. PDAs can reduce decision-making difficulty and lead to better treatment outcomes. We describe the methods for a pilot randomized controlled trial of an interactive web-based PDA for women who are having difficulty deciding about antidepressant drug use in pregnancy.Methods/DesignThis is a pilot randomized controlled trial that aims to assess the feasibility of a larger, multi-center efficacy study. The PDA aims to help a woman: (1) understand why an antidepressant is being recommended, (2) be knowledgeable about potential benefits and risks of treatment and non-treatment with antidepressants, and (3) be clear about which benefits and risks are most important to her, with the goal of improving confidence in her decision-making. We include women aged 18 years or older who are: (1) planning a pregnancy or are pregnant (gestational age less than 30 weeks), (2) diagnosed with major depressive disorder, (3) deciding whether or not to use a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant in pregnancy, and (4) having at least moderate decision-making difficulty as per a Decisional Conflict Scale (DCS) Score ≥25. Participants are randomized to receive the PDA or an informational resource sheet via a secure website, and have access to the stated allocation until their final study follow-up. The primary outcomes of the pilot study are feasibility of recruitment and retention, acceptability of the intervention, and adherence to the trial protocol. The primary efficacy outcome is DCS score at 4 weeks post randomization, with secondary outcomes including depressive and anxiety symptoms.DiscussionOur PDA represents a key opportunity to optimize the decision-making process for women around antidepressants in pregnancy, leading to effective decision-making and optimizing improved maternal and child outcomes related to depression in pregnancy. The electronic nature of the PDA will facilitate keeping it up-to-date, and allow for widespread dissemination after efficacy is demonstrated.Trial registrationThis trial is registered on ClinicalTrials.Gov under the identifier NCT02308592 (first registered: 2 December 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1233-4) contains supplementary material, which is available to authorized users.

Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology.

BackgroundFine needle aspiration (FNA) cytopathology is the gold standard work-up for thyroid nodules. However, indeterminate lesions are encountered commonly and can lead to difficult treatment decisions. We sought to determine whether patients experienced decisional conflict surrounding management with diagnostic thyroidectomy in the setting of indeterminate FNA results.MethodsPatients with indeterminate results of thyroid nodule FNA were prospectively enrolled. All consultations were carried out by three otolaryngologists in a consistent manner. After consultation, participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire.ResultsThirty-five patients (28 female) between the ages of 30 and 88 years (mean age 54.89) participated. The median total DCS score was 10.94 (interquartile range, 4.69–25.0). Twelve patients (34 %) scored at or above 25 on the DCS, indicating clinically significant level of decisional conflict. Patients reported feeling significantly more confident about their decision after the surgical consultation compared to before the consultation (p = 0.00). The total DCS score was significantly negatively correlated with self-reported confidence after the consultation (r = −0.421, p = 0.012).ConclusionMany patients experienced clinically significant decisional conflict when considering thyroidectomy for management of a thyroid nodule with indeterminate cytopathology. Future research should be directed at developing decision support tools for this patient group, and exploring the impact of decisional conflict on health outcomes.

Impact of Genomic Counseling on Informed Decision-Making among ostensibly Healthy Individuals Seeking Personal Genome Sequencing: the HealthSeq Project.

Personal genome sequencing is increasingly utilized by healthy individuals for predispositional screening and other applications. However, little is known about the impact of 'genomic counseling' on informed decision-making in this context. Our primary aim was to compare measures of participants' informed decision-making before and after genomic counseling in the HealthSeq project, a longitudinal cohort study of individuals receiving personal results from whole genome sequencing (WGS). Our secondary aims were to assess the impact of the counseling on WGS knowledge and concerns, and to explore participants' satisfaction with the counseling. Questionnaires were administered to participants (n=35) before and after their pre-test genomic counseling appointment. Informed decision-making was measured using the Decisional Conflict Scale (DCS) and the Satisfaction with Decision Scale (SDS). DCS scores decreased after genomic counseling (mean: 11.34 before vs. 5.94 after; z=-4.34, p<0.001, r=0.52), and SDS scores increased (mean: 27.91 vs. 29.06 respectively; z=2.91, p=0.004, r=0.35). Satisfaction with counseling was high (mean (SD)=26.91 (2.68), on a scale where 6=low and 30=high satisfaction). HealthSeq participants felt that their decision regarding receiving personal results from WGS was more informed after genomic counseling. Further research comparing the impact of different genomic counseling models is needed.

Novel intervention for decision support and distress in female cancer survivors considering fertility preservation.

114 Background: Treatment-related infertility is a source of long-term psychological distress in cancer survivors, particularly among women. Decisions about fertility preservation (FP) are made under conditions of high stress and time pressure, which may contribute to the relatively low uptake of FP among women with cancer. Little is known about the effect of interventions to support the decision-making process and reduce fertility-related distress in cancer survivors considering FP. We describe the design and preliminary data from a randomized trial to determine whether incorporating psychological assessment and intervention into the standard FP consultation enhances satisfaction with decision-making and psychosocial outcomes. Methods: We developed a brief intervention for women referred to our institution’s oncofertility service for consideration of FP. The intervention focuses on values clarification for decision support, identification of unmet psychosocial needs, and mindfulness and acceptance-based skills. Participants were randomized to usual care (consultation with a reproductive endocrinologist and nurse) or the intervention (usual care plus a 1-hour visit with a psychologist and two follow-up calls). Outcomes included feasibility measures and measures of decisional conflict (Decisional Conflict Scale) and satisfaction with the FP program (Client Satisfaction Questionnaire-8). Results: All 14 participants randomized to date have completed baseline and 1-month assessments. The mean age was 32 (SD = 7.5, range 20-44), and the majority were nulliparous (n = 9, 64%). All 7 intervention participants completed at least 1 follow-up call, and 5 (71%) completed both follow-up calls. Across all participants, Decisional Conflict Scale scores decreased from baseline (M = 24.8, SD = 17.2) to 1 month (M = 22.2, SD = 16.3). Overall satisfaction with the program at 1 month was high (M = 29 out of a possible 32). Conclusions: Incorporating a psychological assessment and intervention into a standard FP consultation appears feasible and may improve levels of decisional conflict over time. Women appeared to find the intervention helpful when contemplating FP.

Decision conflict and regret among surrogate decision makers in the medical intensive care unit

IntroductionFamily members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non–end-of-life decisions. MethodsWe enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. ResultsForty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. ConclusionsNearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret.

Prospective assessment of the decision-making impact of the Breast Cancer Index in recommending extended adjuvant endocrine therapy for patients with early-stage ER-positive breast cancer.

Extended adjuvant endocrine therapy (10 vs. 5 years) trials have demonstrated improved outcomes in early-stage estrogen receptor (ER)-positive breast cancer; however, the absolute benefit is modest, and toxicity and tolerability challenges remain. Predictive and prognostic information from genomic analysis may help inform this clinical decision. The purpose of this study was to assess the impact of the Breast Cancer Index (BCI) on physician recommendations for extended endocrine therapy and on patient anxiety and decision conflict. Patients with stage I–III, ER-positive breast cancer who completed at least 3.5 years of adjuvant endocrine therapy were offered participation. Genomic classification with BCI was performed on archived tumor tissues and the results were reported to the treating physician who discussed results with the patient. Patients and physicians completed pre- and post-test questionnaires regarding preferences for extended endocrine therapy. Patients also completed the validated traditional Decisional Conflict Scale (DCS) and State Trait Anxiety Inventory forms (STAI-Y1) pre- and post-test. 96 patients were enrolled at the Yale Cancer Center [median age 60.5 years (range 45–87), 79 % postmenopausal, 60 % stage I). BCI predicted a low risk of late recurrence in 59 % of patients versus intermediate/high in 24 and 17 %, respectively. Physician recommendations for extended endocrine therapy changed for 26 % of patients after considering BCI results, with a net decrease in recommendations for extended endocrine therapy from 74 to 54 %. After testing, fewer patients wanted to continue extended therapy and decision conflict and anxiety also decreased. Mean STAI and DCS scores were 31.3 versus 29.1 (p = 0.031) and 20.9 versus 10.8 (p < 0.001) pre- and post-test, respectively. Incorporation of BCI into risk/benefit discussions regarding extended endocrine therapy resulted in changes in treatment recommendations and improved patient satisfaction.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-015-3631-9) contains supplementary material, which is available to authorized users.

Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients.

Although numerous studies have documented that family members in intensive care units struggle with end-of-life decisions for incapacitated patients, there is little information about whether prior advance care planning lessens the burden of decision making. We sought to measure decisional conflict in surrogates of critically ill patients and to examine whether prior advance care planning is associated with less decisional conflict. We performed a secondary data analysis of a multicenter, prospective cohort study done at five U.S. academic medical centers that included 471 surrogates of 257 patients with acute respiratory distress syndrome. The main outcome was surrogates' burden of decision making as measured using the Decisional Conflict Scale. Surrogates completed a questionnaire item addressing whether they had had any prior advance care planning conversations with their loved ones. We used multilevel linear regression modeling to measure the association between decisional conflict and advance care planning. Moderate or high levels of decisional conflict (Decisional Conflict Scale score≥25) were present in 48% of surrogates. After adjusting for potential confounders, surrogates who had engaged in prior advance care planning conversations had significantly lower levels of decisional conflict than those who had not (mean score 3.3 points lower on the Decisional Conflict Scale; 95% confidence interval, -6.4 to -0.2; P=0.03). Nearly half of surrogates for critically ill patients have moderate or high levels of decisional conflict. Prior advance care planning was associated with less decisional conflict. These results suggest that the scope of the benefit of advance care planning may extend beyond respecting patients' wishes to also ameliorating the burden on patients' loved ones who act as surrogates.

Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening.

Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.

Decisional Conflict in Parents Considering Bone-Anchored Hearing Devices in Children With Unilateral Aural Atresia.

The benefits of bone-anchored hearing devices (BAHD) in children with unilateral aural atresia are controversial. We sought to determine whether there is parental decisional conflict surrounding elective placement of BAHD for this indication. Caregivers of pediatric patients with unilateral aural atresia and normal contralateral ear undergoing percutaneous BAHD consultation were enrolled. All consultations were carried out by one pediatric otolaryngologist in a consistent manner. After consultation, the participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire. Twenty-three caregivers of 15 male (65.2%) and 8 female (34.8%) children (mean age 5.65 years) participated. The overall median DCS score was 15.63 (standard error = 4.21). Significant decisional conflict (DCS score ≥ 25) was found in 10 participants (43.5%). The median DCS score in the group choosing surgery was 5.47, and it was 23.44 in those who did not choose surgery (Mann-Whitney U = 39, Z = -1.391, P = .164). The median DCS score for mothers and fathers was 25 and 3.91, respectively. Many parents experienced significant decisional conflict when considering percutaneous BAHD surgery in children with unilateral aural atresia in our study population. Future research should explore the impact of decisional conflict on health outcomes.

MP78-14 REDUCING DECISIONAL CONFLICT IN MEN MAKING TREATMENT DECISIONS ABOUT LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 2015MP78-14 REDUCING DECISIONAL CONFLICT IN MEN MAKING TREATMENT DECISIONS ABOUT LOCALIZED PROSTATE CANCER David Johnson, Dana Mueller, Mary Dunn, Angela Smith, Michael Woods, Eric Wallen, Raj Pruthi, and Matthew Nielsen David JohnsonDavid Johnson More articles by this author , Dana MuellerDana Mueller More articles by this author , Mary DunnMary Dunn More articles by this author , Angela SmithAngela Smith More articles by this author , Michael WoodsMichael Woods More articles by this author , Eric WallenEric Wallen More articles by this author , Raj PruthiRaj Pruthi More articles by this author , and Matthew NielsenMatthew Nielsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2830AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men with newly diagnosed localized prostate cancer (LPC) face a complex, preference-sensitive treatment decision. Low “decisional conflict” (DC), defined as uncertainty over treatment choice, is a key component of decision quality. Lower scores on the Decisional Conflict Scale (DCS) are associated with lower likelihood of delaying a decision and assessing blame to a physician for bad outcomes. We hypothesized that using a novel software application to measure and report patients' preferences for LPC treatment outcomes as part of a pre-consultation intervention would improve decisional quality in men with LPC by reducing DC. METHODS Men with newly diagnosed LPC completed the online WiserCare (WiserCare, Inc) prostate cancer module prior to their initial consultation at the University of North Carolina, Chapel Hill Multi-disciplinary Urologic Oncology Clinic. WiserCare is a software application that provides education, preference assessment, and personalized decision analysis for patients. Preferences are measured using conjoint analysis. WiserCare then generates an individualized report ranking treatment options based on their “fit”(expected value) based on clinical prognostic factors and personal preferences. This report is used with their physician during counseling. We measured DCS scores before and after completion of the WiserCare module. Paired 2-tailed T-tests were to evaluate the changes in DCS scores. RESULTS 48 men completed the WiserCare module and DCS prior to their initial consultation for newly diagnosed LPC. Overall DCS score decreased by 38% (p<0.00001) after completion of the WiserCare module. Analysis of DCS subscales revealed improvements in all five, including feeling informed by 56% (p<0.00001), value clarity by 49% (p=0.001), feeling effective in decision making by 36% (p=0.0001), feeling supported by 31% (p=0.0037), and reduced uncertainty by 24% (p=0.0023). CONCLUSIONS A pre-consultation web-based module integrating evidence-based information, individualized clinical data and personal preference data is a feasible and effective strategy to reduce DC in men making treatment choices for LPC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1007-e1008 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Johnson More articles by this author Dana Mueller More articles by this author Mary Dunn More articles by this author Angela Smith More articles by this author Michael Woods More articles by this author Eric Wallen More articles by this author Raj Pruthi More articles by this author Matthew Nielsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reducing decisional conflict in men making treatment decisions on newly diagnosed localized prostate cancer.

106 Background: Men with newly diagnosed localized prostate cancer (LPC) face a complex, preference-sensitive treatment decision. Low “decisional conflict” (DC), defined as uncertainty over treatment choice, is a key component of decision quality. Lower scores on the Decisional Conflict Scale (DCS) are associated with lower likelihood of delaying a decision and assessing blame to a physician for bad outcomes. We hypothesized that using a novel software application to measure and report patients’ preferences for LPC treatment outcomes as part of a pre-consultation intervention would improve decisional quality in men with LPC by reducing DC. Methods: Men with newly diagnosed LPC completed the online WiserCare (WiserCare, Inc) prostate cancer module prior to their initial consultation at the University of North Carolina, Chapel Hill Multi-disciplinary Urologic Oncology Clinic. WiserCare is a software application that provides education, preference assessment, and personalized decision analysis for patients. Preferences are measured using conjoint analysis. WiserCare then generates an individualized report ranking treatment options based on their “fit”(expected value) based on clinical prognostic factors and personal preferences. This report is used with their physician during counseling. We measured DCS scores before and after completion of the WiserCare module. Paired 2-tailed T-tests were to evaluate the changes in DCS scores. Results: 48 men completed the WiserCare module and DCS prior to their initial consultation for newly diagnosed LPC. Overall DCS score decreased by 38% (p&lt;0.00001) after completion of the WiserCare module. Analysis of DCS subscales revealed improvements in all five, including feeling informed by 56% (p&lt;0.00001), value clarity by 49% (p=0.001), feeling effective in decision making by 36% (p=0.0001), feeling supported by 31% (p=0.0037), and reduced uncertainty by 24% (p=0.0023). Conclusions: A pre-consultation web-based module integrating evidence-based information, individualized clinical data and personal preference data is a feasible and effective strategy to reduce decisional conflict in men making treatment choices for localized prostate cancer.

Assessment of Breast Cancer Patients' Knowledge and Decisional Conflict Regarding Tamoxifen Use.

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (≥college) was associated with a higher, total knowledge score (β = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (β = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (β = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.

Genders of patients and clinicians and their effect on shared decision making: a participant-level meta-analysis

BackgroundGender differences in communication styles between clinicians and patients have been postulated to impact patient care, but the extent to which the gender dyad structure impacts outcomes in shared decision making remains unclear.MethodsParticipant-level meta-analysis of 775 clinical encounters within 7 randomized trials where decision aids, shared decision making tools, were used at the point of care. Outcomes analysed include decisional conflict scale scores, satisfaction with the clinical encounter, concordance between stated decision and action taken, and degree of patient engagement by the clinician using the OPTION scale. An estimated minimal important difference was used to determine if nonsignificant results could be explained by low power.ResultsWe did not find a statistically significant interaction between clinician/patient gender mix and arm for decisional conflict, satisfaction with the clinical encounter or patient engagement. A borderline significant interaction (p = 0.05) was observed for one outcome: concordance between stated decision and action taken, where encounters with female clinician/male patient showed increased concordance in the decision aid arm compared to control (8% more concordant encounters). All other gender dyads showed decreased concordance with decision aid use (6% fewer concordant encounters for same-gender, 16% fewer concordant encounters for male clinician/female patient).ConclusionsIn this participant-level meta-analysis of 7 randomized trials, decision aids used at the point of care demonstrated comparable efficacy across gender dyads. Purported barriers to shared decision making based on gender were not detected when tested for a minimum detected difference.Trial registrationsClinicalTrials.gov NCT00888537, NCT01077037, NCT01029288, NCT00388050, NCT00578981, NCT00949611, NCT00217061.

A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels.

Patients with potentially indolent prostate cancer (PC) can be managed with active surveillance (AS). Our objective was to analyse how anxiety and distress develop in men with untreated PC and whether highly anxious men quit AS. One hundred and fifty Dutch patients who opted for AS in the Prostate cancer Research International: Active Surveillance Study were invited to participate in an additional prospective, longitudinal quality of life (QoL) study within 6 months after diagnosis. Participants completed questionnaires with validated measures on anxiety and distress at inclusion (t = 0), 9 (t = 9) and 18 (t = 18) months after diagnosis. We assessed changes in scores on depression (Center for Epidemiologic Studies Depression (CES-D) scale), generic anxiety (State-Trait Anxiety Inventory (STAI-6)), PC-specific anxiety (Memorial Anxiety Scale for Prostate Cancer (MAX-PC)) and decisional conflict (Decisional Conflict Scale (DCS)) about patients' treatment choice between t = 0, t = 9 and t = 18 using repeated measures analysis. Response rates for patients still on AS at t = 0, t = 9 and t = 18 assessments were 86%, 90% and 96%, respectively. Nine patients (7%, 9/129) between t = 0 and t = 9 and 33 of 108 patients (31%) between t = 9 and t = 18 stopped AS, mostly (86%) because of protocol-based reasons. CES-D, total MAX-PC and DCS scores did not change significantly (p > 0.05) when comparing t = 18 with t = 9 and t = 0 scores, but generic anxiety (STAI-6; p = 0.033) and fear of disease progression (sub-score of the MAX-PC; p = 0.007) decreased significantly. These differences, however, were clinically modest (0.089 SD and 0.281 SD). Overall, six of 129 men (5%) discontinued AS because of anxiety and distress. When men with low-risk PC are managed with AS, fear of disease progression and general anxiety decreased, and only few may discontinue AS because of anxiety and distress. This suggests that negative QoL effects are limited in men with favourable clinical characteristics who opted for AS. (Registered trial number, NTR1718) .

MP15-03 PREDICTORS OF DECISIONAL CONFLICT IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER: BASELINE RESULTS FROM A SHARED DECISION-MAKING TRIAL

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2014MP15-03 PREDICTORS OF DECISIONAL CONFLICT IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER: BASELINE RESULTS FROM A SHARED DECISION-MAKING TRIAL Alan L. Kaplan, MD Catherine M. Crespi, Ph.D. Josemanuel Saucedo, MPH Ely Dahan, Ph.D, MBA Sylvia Lambrechts, MPH, MA Robert Kaplan, andPh.D. Christopher SaigalMD, MPH Alan L. KaplanAlan L. Kaplan More articles by this author , Catherine M. CrespiCatherine M. Crespi More articles by this author , Josemanuel SaucedoJosemanuel Saucedo More articles by this author , Ely DahanEly Dahan More articles by this author , Sylvia LambrechtsSylvia Lambrechts More articles by this author , Robert KaplanRobert Kaplan More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.556AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men diagnosed prostate cancer face a major decision that may significantly impact their quality of life. “Decisional conflict” is a measure of the uncertainty surrounding a treatment choice and a patient’s confidence in making this choice. Decisional conflict is a source of anxiety and stress and is a key factor in decision quality, but little data exists to help the urologist identify which patients are at risk. To identify predictors of baseline decisional conflict, we conducted a cross-sectional study of men with newly diagnosed localized prostate cancer before any treatment choices were made. METHODS We surveyed 68 men at a Veterans Administration clinic with newly diagnosed localized prostate cancer enrolled in an ongoing randomized trial evaluating decision quality associated with a novel shared decision making approach involving preference assessment. Demographic, clinical, and functional data were collected at baseline. Candidate predictors included age, race, education, comorbidity, relationship status, baseline urinary or sexual dysfunction, and prostate cancer knowledge. Tested outcome variables were total Decisional Conflict Scale (DCS) score, Uncertainty Subscale, and Perceived Effectiveness Subscale. We used multiple linear regression modeling to identify predictors of decisional conflict. RESULTS Mean age was 63 years, 49% were of African American race, and 70% reported an income less than $30,000. Older age was associated with lower perceived effectiveness of decision making (p=0.005). Poor prostate cancer knowledge was associated with increased overall decisional conflict and higher uncertainty (p<0.001 and p=0.001, respectively). Poor knowledge also predicted lower perceived effectiveness (p=0.003). Being in a relationship was associated with less decisional conflict (p=0.03). CONCLUSIONS We find that decreased knowledge about prostate cancer is associated with increased decisional conflict and lower perceived effective decision making. Interventions aimed at increasing comprehension of prostate cancer and its treatments may reduce decisional conflict and raise decisional quality. Additionally, increasing age is a risk factor for lowered perceived effective decision making. Further work is required to better characterize this relationship and identify potential mitigators. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e144-e145 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alan L. Kaplan More articles by this author Catherine M. Crespi More articles by this author Josemanuel Saucedo More articles by this author Ely Dahan More articles by this author Sylvia Lambrechts More articles by this author Robert Kaplan More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

To preserve or not to preserve

The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS). The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables. Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]). In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions.

Validation of SURE, a Four-Item Clinical Checklist for Detecting Decisional Conflict in Patients

We sought to determine the psychometric properties of SURE, a 4-item checklist designed to screen for clinically significant decisional conflict in clinical practice. This study was a secondary analysis of a clustered randomized trial assessing the effect of DECISION+2, a 2-hour online tutorial followed by a 2-hour interactive workshop on shared decision making, on decisions to use antibiotics for acute respiratory infections. Patients completed SURE and also the Decisional Conflict Scale (DCS), as the gold standard, after consultation. We evaluated internal consistency of SURE using the Kuder-Richardson 20 coefficient (KR-20). We compared DCS and SURE scores using the Spearman correlation coefficient. We assessed sensitivity and specificity of SURE scores (cut-off score ≤3 out of 4) by identifying patients with and without clinically significant decisional conflict (DCS score >37.5 on a scale of 0-100). Of the 712 patients recruited during the trial, 654 completed both tools. SURE scores showed adequate internal consistency (KR-20 coefficient of 0.7). There was a significant correlation between DCS and SURE scores (Spearman's ρ = -0.45, P < 0.0001). The prevalence of clinically significant decisional conflict as estimated by the DCS was 5.2% (95% CI 3.7-7.3). Sensitivity and specificity of SURE ≤3 were 94.1% (95% CI 78.9-99.0) and 89.8% (95% CI 87.1-92.0), respectively. SURE shows adequate psychometric properties in a primary care population with a low prevalence of clinically significant decisional conflict. SURE has the potential to be a useful screening tool for practitioners, responding to the growing need for detecting clinically significant decisional conflict in patients.

Development and validation of the Japanese version of the Decisional Conflict Scale to investigate the value of pharmacists’ information: a before and after study

BackgroundThe information provided in patient-centered care and shared decision-making influences patients’ concerns and adherence to treatment. In the decision-making process, patients experience decisional conflict. The Decisional Conflict Scale (DCS) is a 16-item, self-administered questionnaire consisting of 5 subscales developed to assess patients’ decisional conflict. This study aimed to develop the Japanese version of the DCS and to clarify the influence of the information provided by pharmacists’ on decisional conflict among patients with cancer.MethodsWe developed the Japanese version of the DCS by using the forward-backward translation method. One hundred patients who were recommended a new chemotherapy regimen were recruited. The psychometric properties of the Japanese DCS, including internal consistency, convergent validity, discriminant validity, and construct validity, were examined. We assessed the decisional conflict of patients before and after the pharmacists’ provision of information.ResultsNinety-four patients, predominately female, with an average age of 58.1 years were sampled. The scores on the 5 subscales of the DCS showed high internal consistency (Cronbach’s alpha = 0.84–0.96). Multi-trait scaling analysis and cluster analysis showed strong validity. The mean total DCS score decreased significantly from 40.2 to 31.7 after patients received information from the pharmacists (p < 0.001, paired t-test). Scores on all 5 subscales, namely, uncertainty, informed, values clarity, support, and effective decision, also significantly improved (p < 0.001 for all categories, paired t-test).ConclusionsThe psychometric properties of the Japanese version of the DCS are considered appropriate for it to be administered to patients with cancer. Pharmacists’ provision of information was able to decrease decisional conflict among patients with cancer who were recommended a new chemotherapy regimen.

患者の治療選択における意思決定の葛藤を指標とした薬剤師の服薬カウンセリング効果の定量的評価法

The purpose of this before-after study was to examine the psychometric properties of the Japanese version of the Decisional Conflict Scale (DCS) and to analyze the impact of pharmacist counseling on decisional conflict for patients infected with the human immunodeficiency virus (HIV). Internal consistency reliability was calculated. Multi-trait scaling and cluster analyses were performed to measure construct validity. In addition, decisional conflict in the patients infected with HIV was assessed before and after they received information from pharmacists. Data collected from 69 patients who were recommended a new anti-retroviral therapy were analyzed. A high degree of internal consistency was observed for the five subscales of the DCS (Cronbach's alpha = 0.78 - 0.90). Multi-trait scaling and cluster analyses indicated good construct validity. After the pharmacist counseling, the mean total DCS score decreased significantly (ie, from 46.3 to 26.5, P < 0.0001, paired t-test). Scores on all subscales of the DCS showed statistically significant improvement (Ps < 0.0001, paired t-test). This paper concludes that the Japanese version of the DCS is psychometrically sound for patients infected with HIV. Before initiating anti-retroviral therapy, these patients have high decisional conflict, which can be improved by pharmacist counseling.