Decisional Conflict Scores Research Articles

Shared decision-making support program for older patients with advanced cancer using a question prompt list and geriatric assessment: A pilot randomized controlled trial

IntroductionOlder patients with cancer are less likely to express their treatment preferences than younger patients. Question prompt lists (QPLs) facilitate communication between patients and physicians. Geriatric assessment (GA) is recommended when older patients with cancer make treatment decisions. This study estimated the effect size of a shared decision-making (SDM) support program combining QPLs with GA in terms of patients' subjective evaluation of the SDM process for a future definitive randomized controlled trial. We also evaluated the number and quality of aging-related communication during consultations, and feasibility and acceptability of the study for exploratory purposes. Materials and MethodsThis is a pilot study with randomized allocation and blind evaluation. Patients aged 65 years or older at the National Cancer Center Hospital, Tokyo, Japan, scheduled to discuss the changes of their treatment, were randomly assigned in a 1:1 ratio to the SDM support program or usual care. This program consisted of 30–60 min of face-to-face coaching, with QPLs and GA provided before the coaching. As the primary endpoint, the decisional conflict scores given by the patients immediately after the consultation were compared between the two groups. For the secondary endpoints, the number and quality of aging-related communications during the consultations were assessed by evaluators (blinded) using audio-recordings. Adherence, burden, and usefulness were assessed for evaluating feasibility and acceptability of the SDM support program. ResultsForty patients were enrolled. All patients completed the GA questionnaire, for which 70% did not require any individual assistance. Answering the questionnaires took approximately 11 min. The decisional conflict scores were mean [standard deviation (SD)]: 19.3 [10.8] vs. 18.0 [11.1] (effect size: Cohen's d = 0.12) for the SDM support program and usual care groups, respectively. The number of aging-related communications during the consultation for the new treatment was higher in the SDM support program group than the usual care (mean [SD]: 3.3 [1.2] vs. 2.2 [1.5], effect size: cohen's d = 1.32). Patients felt that the SDM support program was useful but not burdensome or difficult. DiscussionThe SDM support program was considered useful and feasible for older patients and able to facilitate communication regarding aging-related concerns. Trial registration numberThe study protocol was registered on September 23, 2020, in the UMIN Clinical Trials Registry (UMIN000041867).

A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women

Tubal sterilization is common, especially among individuals with low income. There is substantial misunderstanding about sterilization among those who have undergone the procedure, suggesting suboptimal decision-making about a method that permanently ends reproductive capacity. To test the efficacy of a web-based decision aid for improving tubal sterilization decision quality. This randomized clinical trial conducted between March 2020 and November 2023 included English- or Spanish-speaking pregnant cisgender women aged 21 to 45 years who had Medicaid insurance and were contemplating tubal sterilization after delivery. Participants were recruited from outpatient obstetric clinics in 3 US cities. Participants were randomized 1:1 to usual care (control arm) or to usual care plus a web-based decision aid (MyDecision/MiDecisión) (intervention arm). The aid includes written, audio, and video information about tubal sterilization procedures; an interactive table comparing contraceptive options; values-clarifying exercises; knowledge checks; and a summary report. The co-primary outcomes were tubal sterilization knowledge and decisional conflict regarding the contraceptive decision. Knowledge was measured as the percentage of correct responses to 10 true-false items. Decisional conflict was measured using the low-literacy Decision Conflict Scale, with lower scores on a range from 0 to 100 indicating less conflict. Among the 350 participants, mean (SD) age was 29.7 (5.1) years. Compared with the usual care group, participants randomized to the decision aid had significantly higher tubal sterilization knowledge (mean [SD] proportion of questions answered correctly, 76.5% [16.9%] vs 55.6% [22.6%]; P < .001) and lower decisional conflict scores (mean [SD], 12.7 [16.6] vs 18.7 [20.8] points; P = .002). The greatest knowledge differences between the 2 groups were for items about permanence, with more participants in the intervention arm answering correctly that tubal sterilization is not easily reversible (90.1% vs 39.3%; odds ratio [OR], 14.2 [95% CI, 7.9-25.4]; P < .001) and that the tubes do not spontaneously "come untied" (86.6% vs 33.7%; OR, 13.0 [95% CI, 7.6-22.4]; P < .001). MyDecision/MiDecisión significantly improved tubal sterilization decision-making quality compared with usual care only. This scalable decision aid can be implemented into clinical practice to supplement practitioner counseling. These results are particularly important given the recent increase in demand for permanent contraception after the US Supreme Court decision overturning federal abortion protections. ClinicalTrials.gov Identifier: NCT04097717.

Testing of a risk-stratified patient decision aid to facilitate shared decision-making for extended postoperative thromboprophylaxis after major abdominal surgery for cancer.

Use of extended pharmacologic thromboprophylaxis after major abdominopelvic cancer surgery should depend on best-available scientific evidence and patients' informed preferences. We developed a risk-stratified patient decision aid to facilitate shared decision-making and sought to evaluate its effect on decision-making quality regarding use of extended thromboprophylaxis. We enrolled patients undergoing major abdominopelvic cancer surgery at an academic tertiary care centre in this pre-post study. We evaluated change in decisional conflict, readiness to decide, decision-making confidence, and change in patient knowledge. Participants were provided the appropriate risk-stratified decision aid (according to their Caprini score) in either the preoperative or postoperative setting. A sample size calculation determined that we required 17 patients to demonstrate whether the decision aid meaningfully reduced decisional conflict. We used the Wilcoxon matched-pairs signed ranks test for interval scaled measures. We included 17 participants. The decision aid significantly reduced decisional conflict (median decisional conflict score 2.37 [range 1.00-3.81] v. 1.3 [range 1.00-3.25], p < 0.01). With the decision aid, participants had high confidence (median 86.4 [range 15.91-100]) and felt highly prepared to make a decision (median 90 [range 55-100]). Median knowledge scores increased from 50% (range 0%-100%) to 75% (range 25%-100%). Our risk-stratified, evidence-based decision aid on extended thromboprophylaxis after major abdominopelvic surgery significantly improved decision-making quality. Further research is needed to evaluate the usability and feasibility of this decision aid in the perioperative setting.

Effectiveness of an Advance Care Planning Intervention in Adults Receiving Dialysis and Their Families

Evidence of effectiveness of advance care planning (ACP) strategies for patients receiving dialysis and their families is needed. To test the effectiveness of an ACP intervention to prepare patients and their surrogates for end-of-life (EOL) decision-making and to improve surrogate bereavement outcomes. This cluster randomized clinical trial, An Effectiveness-Implementation Trial of SPIRIT (Sharing Patients' Illness Representations to Increase Trust) in ESRD, was conducted from December 2017 to March 2023 and included 42 dialysis clinics in 5 US states (Georgia, New Mexico, North Carolina, Pennsylvania, and Virginia) randomized to provide intervention or usual care. Recruitment was from February 15, 2018, to January 31, 2022, and patient-surrogate dyads were followed up for 21 months (until January 17, 2023) or until patient death. Each clinic selected 1 or 2 health care workers (eg, nurse practitioner, registered nurse, or social worker) to conduct 45- to 60-minute ACP discussions with dyads in the clinic or remotely. After March 13, 2020 (commencement of the COVID-19 emergency declaration), all discussions were conducted remotely. An ACP summary was placed in patients' medical records. The primary, 2-week preparedness outcomes were dyad congruence on EOL goals of care, patient decisional conflict, surrogate decision-making confidence, and a composite of dyad congruence and surrogate decision-making confidence. Secondary bereavement outcomes were anxiety, depression, and posttraumatic distress 3 months after patient death. To adjust for COVID-19 pandemic effects on bereavement outcomes, a variable to indicate the timing of baseline and 3-month assessment relative to the COVID-19 emergency declaration was created. Of the 426 dyads enrolled, 231 were in the intervention clinics, and 195 were in the control clinics. Among all dyads, the mean (SD) patient age was 61.9 (12.7) years, and the mean (SD) surrogate age was 53.7 (15.4) years. At 2 weeks, after adjusting for baseline values, dyad congruence (odds ratio [OR], 1.61; 95% CI, 1.12-2.31; P = .001), decisional conflict scores (β, -0.10; 95% CI, -0.13 to -0.07; P < .001), and the composite (OR, 1.57; 95% CI, 1.06-2.34; P = .03) were higher in the intervention group than in the control group. Surrogate decision-making confidence was similar between groups (β, 0.06; 95% CI, -0.01 to 0.13; P = .12). Among 77 bereaved surrogates, after adjusting for baseline values and assessment timing, intervention group anxiety was lower than control group anxiety (β, -1.55; 95% CI, -3.08 to -0.01; P = .05); however, depression (β, -0.18; 95% CI, -2.09 to 1.73; P = .84) and posttraumatic distress (β, -0.96; 95% CI, -7.39 to 5.46; P = .75) were similar. In this randomized clinical trial, the ACP intervention implemented by health care workers at dialysis centers improved preparation for EOL decision-making but showed mixed effectiveness on bereavement outcomes. The ACP intervention implemented in dialysis centers may be an effective strategy to the dyad preparation for end-of-life care as opposed to the current focus on advance directives. ClinicalTrials.gov Identifier: NCT03138564.

A formalized shared decision-making process with individualized decision aids for older patients referred for cardiac surgery.

Comprehension of risks, benefits and alternative treatment options is poor among patients referred for cardiac surgery interventions. We sought to explore the impact of a formalized shared decision-making (SDM) process on patient comprehension and decisional quality among older patients referred for cardiac surgery. We developed and evaluated a paper-based decision aid for cardiac surgery within the context of a prospective SDM design. Surgeons were trained in SDM through a Web-based program. We acted as decisional coaches, going through the decision aids with the patients and their families, and remaining available for consultation. Patients (aged ≥ 65 yr) undergoing isolated valve, coronary artery bypass graft (CABG) or CABG and valve surgery were eligible. Participants in the non-SDM phase followed standard care. Participants in the SDM group received a decision aid following cardiac catheterization, populated with individualized risk assessment, personal profile and comorbidity status. Both groups were assessed before surgery on comprehension, decisional conflict, decisional quality, anxiety and depression. We included 98 patients in the SDM group and 97 in the non-SDM group. Patients who received decision aids through a formalized SDM approach scored higher in comprehension (median 15.0, interquartile range [IQR] 12.0-18.0) than those who did not (median 9.0, IQR 7.0-12.0, p < 0.001). Decisional quality was greater in the SDM group (median 82.0, IQR 73.0-91.0) than in the non-SDM group (median 76.0, IQR 62.0-82.0, p < 0.05). Decisional conflict scores were lower in the SDM group (mean 1.76, standard deviation [SD] 1.14) than in the non-SDM group (mean 5.26, SD 1.02, p < 0.05). Anxiety and depression scores showed no significant difference between groups. Institution of a formalized SDM process including individualized decision aids improved comprehension of risks, benefits and alternatives to cardiac surgery, as well as decisional quality, and did not result in increased levels of anxiety.

Effectiveness of evidence-based decision aids for women with pathogenic BRCA1 or BRCA2 variants in the german health care context: results from a randomized controlled trial

BackgroundWomen with pathogenic BRCA1 or BRCA2 variants are at high risk for breast and ovarian cancer. Preventive options include risk-reducing breast and ovarian surgeries and intensified breast surveillance. However, individual decision-making is often associated with decisional conflicts. Two evidence-based decision aids have recently been developed for these women (healthy or with unilateral breast cancer) for the German context to support them in their decision-making process. This study evaluated their effectiveness.MethodsIn a randomized controlled study, women (aged 18–70 years) with pathogenic BRCA1 or BRCA2 variants were randomly assigned 1:1 to the intervention (IG, n = 230) or control (CG, n = 220) group. All participants received usual care. After baseline survey (t0), IG participants additionally received the DAs. Follow-up surveys were at three (t1) and six (t2) months. Primary outcome was decisional conflict at t1. Secondary analyses included decision status, decision regret, knowledge on risks and preventive options, self-reported psychological symptoms, acceptability of DAs, and preparation for decision-making.ResultsOf 450 women recruited, 417 completed t0, 398 completed t1 and 386 completed t2. Compared to CG, IG participants had lower decisional conflict scores at t1 (p = 0.049) and t2 (p = 0.006) and higher scores for knowledge (p = 0.004), acceptability (p = 0.000), and preparation for decision-making (p < 0.01).ConclusionsThese DAs can help improve key parameters of decision-making in women with pathogenic BRCA1 and BRCA2 variants and, thus, provide a useful add-on to the current counseling and care concept for these women in Germany.Trial registrationGerman Clinical Trials Register, DRKS-ID: DRKS00015823, retrospectively registered 14/06/2019.

Decision Self-Efficacy and Decisional Conflict on Reintubation among Surrogates of Ventilated Patients Undergoing Planned Extubation

PurposeAlthough the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified. MethodsThis study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients’ background information was also collected. Univariate and multivariate analyses were performed to model the data. ResultsThe mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates’ negative affect on decisional conflict was fully mediated by decision self-efficacy. ConclusionsSurrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.

Evaluating the Acceptability and Feasibility of a Sexual Health-Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study.

Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid-Healthy Sex Choices-designed to support diverse young adults with their contraceptive decision-making. This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Participants were satisfied with the tool, rating the acceptability as "good." Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations.

Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands

BackgroundSince 2007 all pregnant women in the Netherlands are offered the second-trimester anomaly scan (SAS) in a nationwide prenatal screening program. This study aims to assess the level of informed choice of women opting for the SAS and to evaluate the presence of routinization 16 years after its implementation. It further explores decisional conflict and women’s decision making.MethodsThis prospective national survey study consisted of an online questionnaire which was completed after prenatal counseling and before undergoing the SAS. Informed choice was measured by the adapted multidimensional measure of informed choice (MMIC) and was defined in case women were classified as value-consistent, if their decision for the SAS was deliberated and made with sufficient knowledge.ResultsA total of 894/1167 (76.6%) women completed the questionnaire. Overall, 54.8% made an informed choice, 89.6% had good knowledge, 59.8% had deliberated their choice and 92.7% held a positive attitude towards the SAS. Women with low educational attainment (p=0.004) or respondents of non-Western descent (p=0.038) were less likely to make an informed choice. Decisional conflict was low, with a significantly lower decisional conflict score in women that made an informed choice (p<0.001). Most respondents (97.9%) did not perceive pressure to undergo the SAS.ConclusionsOur study showed a relatively low rate of informed choice for the SAS, due to absence of deliberation. Therefore, some routinization seem to be present in the Netherlands. However, most women had sufficient knowledge, did not perceive pressure and experienced low decisional conflict.

The Impact of Shared Decision-Making on the Quality of Decision Making in Aortic Dissection: A before-and-after Comparison Study.

Complex surgical plans and consideration of risks and benefits often cause decisional conflicts for decision-makers in aortic dissection (AD) surgery, resulting in decision delay. Shared decision-making (SDM) improves decision readiness and reduces decisional conflicts. The purpose of this study was to investigate the impact of SDM on decision quality in AD. One hundred and sixty AD decision-makers were divided into two groups: control (n = 80) and intervention (n = 80). The surgical plan for the intervention group was determined using patient decision aids. The primary outcome was decisional conflict. Secondary outcomes included decision preparation, decision satisfaction, surgical method, postoperative complications, actual participation role, and duration of consultation. The data were analyzed with SPSS 26.0 (IBM Corp., Chicago, IL, USA). p 0.05 was considered statistically significant. The decisional conflict score was significantly lower in the intervention group than in the control group (p 0.001). The decision preparation and decision satisfaction scores in the intervention group were significantly higher than those in the control group (p 0.001). There were more SDM decision-makers in the intervention group (16 [20%] vs. 42 [52.50%]). There was no statistical significance in the choice of surgical, postoperative complications, duration of consultation, and hospital and post-operative intensive care unit stay time (p = 0.267, p = 0.130, p = 0.070, p = 0.397, p = 0.421, respectively). Income, education level, and residence were the influencing factors of decision-making conflict. SDM can reduce decisional conflict, improve decision preparation and satisfaction, and help decision-makers actively participate in the medical management of patients with AD without affecting the medical outcome.

Implementation of a Novel Patient Decision Aid for Women with Elevated Breast Cancer Risk Who Are Considering MRI Screening: A Pilot Study.

To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening. This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability. Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow. This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.

Decisional conflict, anxiety, and social support among Chinese pregnant women making further prenatal testing decisions

ABSTRACT Objective This study aimed to examine decisional conflict and identify its predictors in Chinese pregnant women who were making decisions about further prenatal testing after receiving a screening result of high-risk for Down syndrome. Method A cross-sectional study was conducted from September 2020 to July 2021 in Guangzhou, China. Two-hundred and sixty pregnant women receiving a screening result of high-risk for Down syndrome completed a questionnaire comprising the Decisional Conflict Scale, Self‐rating Anxiety Scale, and Social Support Rating Scale. Results The mean decisional conflict score was 28.8 ± 13.6, representing a moderate level. Advanced age (≥35 years), having a religious belief, not knowing about non-invasive or invasive prenatal testing, choosing NIPT for further prenatal testing, high levels of anxiety, and low levels of social support were significant predictors of decisional conflict, explaining 28.4% of its variance (F = 18.115, p < 0.001). Conclusions The results highlighted the necessity of assessing patients’ decisional conflict and providing adequate interventions along the prenatal care trajectory. The results also showed that providing good support has an essential value for women by relieving their decisional conflict.

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

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.

Development and pilot of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT)

PurposeEvidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).Design/methodology/approachADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.FindingsOf the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).Originality/valueADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.

Decisional conflict among health care workers regarding the covid 19 vaccine

IntroductionThe introduction of the covid 19 vaccine was a long-awaited event. However, many concerns accompanied this vaccine and the decision to be vaccinated was conflicting, especially among the most vulnerable population at that time, the health care workers.ObjectivesEvaluate the decisional conflict among health care workers concerning the launch of the covid19 vaccination campaign.MethodsThis is a descriptive study conducted by a questionnaire posted on social networks using Google Forms targeting groups of health professionals before the launch of the vaccination campaign in Tunisia from January 16, 2021 to March 6, 2021.We collected sociodemographic data and the attitudes of health care workers about COVID 19 vaccination. We used SURE score to screen the decisional conflict related to COVID 19 vaccine.ResultsOur study included 168 health care workers represented mainly by medical personnel (81% of the respondents). The average age was 34 ±10 years and sex ratio was 0.22.Sixty percent (60%) of population were hesitant about the COVID 19 vaccine. Scientific sources were consulted by 61% and non-scientific sources were referred to by 19%. Seven percent (7%) did not use any information source.The SURE decisional conflict score: the mean was 2.26 ± 1.35. The majority of our population (74.4%) had SURE scores in favour of a decisional conflict. We found that decisional conflict was significantly related to information sources. This conflict was highest amoung health care workers who did not use scientific information sources to inquire about the vaccine.ConclusionsThe announcement of the covid 19 vaccination campaigns raised a significant decisional conflict among the health care workers. Screening for decisional conflict among this population is important. Specific interventions to reduce this conflict are recommended by incorporating decision support tools (Decison Aids) and the shared decision making approach.Disclosure of InterestNone Declared

Development and Validation of a Patient Decision Aid for the Treatment of Ankle Arthritis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Choosing a treatment course can be challenging for patients with ankle osteoarthritis given the multiple operative and nonoperative options. We developed and validated the Ankle Arthritis Patient Decision Aid as a tool to improve shared decision-making for such patients. Methods: Eighty patients of 2 surgeons at a US academic foot and ankle practice were recruited from October 2020 to June 2021 using an electronic medical record messaging system. Participants reviewed the tool and answered survey questions evaluating its quality and factors affecting treatment choice in a hypothetical patient scenario. We evaluated the tool using decisional conflict scores (maximum, 40 points, with higher scores indicating greater uncertainty), pre- and post-knowledge test scores (maximum, 8 points), and helpfulness scores (maximum, 7 points). We compared pre- and post-test knowledge scores using paired Student t- tests. Alpha=.05. Results: Mean (+- standard deviation) knowledge scores improved from 4.8 +- 1.2 (pre-test) to 6.7 +- 1.3 (post-test), for a mean improvement of 1.9 +- 1.4 (p&lt;.001). The mean decisional conflict score was 4.1 +- 5.7, reflecting minimal uncertainty. Factors greatly affecting participants' treatment choices were desire to maintain a high level of physical activity (n=58), risk of complications (n=35), recovery time (n=33), and risk of increased rate of arthritis in adjacent joints (n=32). The mean reported helpfulness score was 5.9 +- 1.2, reflecting substantial benefit. Conclusion: The Ankle Arthritis Patient Decision Aid is a comprehensible tool that significantly improves patient knowledge regarding treatment options for ankle arthritis.

The effects of an online decision aid to support the reproductive decision-making process of genetically at risk couples-A pilot study.

Couples at risk of transmitting a genetic disease to their offspring may experience doubts about their reproductive options. This study examines the effects of an online decision aid (DA) on the (joint) reproductive decision-making process of couples (not pregnant at time of inclusion) at risk of transmitting a genetic disease to their offspring. The primary outcome is decisional conflict, and secondary outcomes are knowledge, realistic expectations, deliberation, joint informed decision-making, and decisional self-efficacy. These outcomes were measured with a pretest-posttest design: before use (T0), after use (T1), and 2 weeks after use (T2) of the decision aid (DA). Usability of the DA was assessed at T1. Paired sample t-tests were used to compute differences between baseline and subsequent measurements. The comparisons of T0-T1 and T0-T2 indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict scores. Furthermore, use of the DA led to increased knowledge, improved realistic expectations, and increased levels of deliberation, with higher increase in participants with low baseline scores. Decision self-efficacy only improved for participants with lower baseline scores. Participants indicated that the information in the DA was comprehensible and clearly organized. These first results indicate that this online DA is an appropriate tool to support couples at risk of transmitting a genetic disease and a desire to have (a) child(ren) in their reproductive decision-making process.

Effects of naturalistic decision-making model-based oncofertility care education for nurses and patients with breast cancer: a cluster randomized controlled trial.

PurposeThis study examined the effects of an oncofertility education program on decisional conflict in nurses and patients with breast cancer.MethodsA cluster randomized controlled trial was conducted with 84 nurses of five breast care units. Three units were randomly selected from the five as the nurse experimental group. Nurses at the experimental group accepted the oncofertility education based on the naturalistic decision-making (NDM) model, while those at the control group accepted the other non-oncofertility education. We also collected data from female patients before and after the nurses’ educational training, respectively. The decisional conflict was measured using the Chinese version of the decisional conflict scale.ResultsNurses in the experimental group had less decisional conflict after the oncofertility educational intervention than those in the control group. After the intervention, nurses with higher infertility knowledge scores had significantly lower decisional conflict. Single nurses had significantly higher decisional conflict than married nurses. A higher perceived barrier score was significantly associated with a higher decisional conflict score. Among patients with the same fertility intention scores, those in the experimental group had lower decisional conflict scores than those in the control group.ConclusionsOur work demonstrates that NDM-based oncofertility care education is feasible and acceptable to improve nurse and patient decisional conflict. Educational training based on the NDM model decreased the decisional conflict regarding oncofertility care.Trial registration.ClinicalTrials.gov Identifier: NCT04600869.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-07279-w.

Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial

BackgroundStage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients.MethodsThis is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes.ResultsAn increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ2 = 6.763, P = 0.009) and effects of kidney disease (Wald χ2 = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ2 = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64).ConclusionsThe BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict.Trial RegistrationClinicalTrials.gov Protocol Registration, NCT03378700. Registered July 12 2017.