Decisional Conflict Scores Research Articles

"Please listen to me": A cross-sectional study of experiences of seniors and their caregivers making housing decisions.

BackgroundLittle is known about the decision-making experiences of seniors and informal caregivers facing decisions about seniors’ housing decisions when objective decision making measures are used.ObjectivesTo report on seniors’ and caregivers’ experiences of housing decisions.DesignA cross-sectional study with a quantitative approach supplemented by qualitative data.SettingSixteen health jurisdictions providing home care services, Quebec province, Canada.ParticipantsTwo separate samples of seniors aged ≥ 65 years and informal caregivers of cognitively impaired seniors who had made a decision about housing.MeasurementsInformation on preferred choice and actual choice about housing, role assumed in the decision, decisional conflict and decision regret was obtained through closed-ended questionnaires. Research assistants paraphrased participants’ narratives about their decision-making experiences and made other observations in standardized logbooks.ResultsThirty-one seniors (median age: 85.5 years) and 48 caregivers (median age: 65.1 years) were recruited. Both seniors and caregivers preferred that the senior stay at home (64.5% and 71.7% respectively). Staying home was the actual choice for only 32.2% of participating seniors and 36.2% of the seniors cared for by the participating caregivers. Overall, 93% seniors and 71% caregivers reported taking an active or collaborative role in the decision-making process. The median decisional conflict score was 23/100 for seniors and 30/100 for caregivers. The median decision regret score was the same for both (10/100). Qualitative analysis revealed that the housing decision was influenced by factors such as seniors’ health and safety concerns and caregivers’ burden of care. Some caregivers felt sad and guilty when the decision did not match the senior’s preference.ConclusionThe actual housing decision made for seniors frequently did not match their preferred housing option. Advanced care planning regarding housing and better decision support are needed for these difficult decisions.

A Randomized Trial to Assess the Effects of Motivational Interviewing Workshops to Decrease Decisional Conflict in Women with Pelvic Floor Disorders

Objectives: Pelvic floor disorders significantly affect quality of life yet decisional conflict may arise when patients are choosing treatments. Objectives: (1) Assess effects of small group workshops led by a nurse continence advisor and psychologist on decisional conflict scores related to pelvic floor disorder treatments; (2) Assess patient satisfaction with workshop.

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples’ decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest–posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.

Decisional Quality in Patients With Small Renal Masses

To measure decisional quality in patients being counseled on treatment for small renal masses and identify potential areas of improvement. A total of 73 patients diagnosed with small renal masses at the University of California, Los Angeles Health completed an instrument measuring decisional conflict, patient satisfaction with care, disease-specific knowledge, and patient impression that shared decision-making occurred in the visit after counseling by a specialist. Participant characteristics were compared between those with high and low decisional conflict using chi-square or Student t test (or Wilcoxon rank-sum test). Participants were mostly older (mean age 63.5), white (84%), in a relationship (61%), and unemployed or retired (63%). Mean knowledge score was 59% correct. The mean (standard deviation) decisional conflict score was 16.4 (18.4) indicating low levels of decisional conflict but with a wide range of scores. Comparing participants with high decisional conflict with those with low decisional conflict, there were significant differences in knowledge scores (Wilcoxon P = .0069), patient satisfaction with care (P = .0011), and perceived shared decision-making (P <.0001). Patients with small renal masses generally have low levels of decisional conflict and can identify a preferred treatment after a physician visit. However, both groups lack overall knowledge about their disease even after counseling, and thus may be heavily influenced by paternalistic care. Those patients with decisional conflicts are less likely to perceive their care as satisfactory and are less likely to be involved in decision-making.

Decisional conflict and regret: shared decision-making about pregnancy affected by β-thalassemia major in Southeast of Iran.

To study the effect of shared decision-making (SDM) on decisional conflict (DC) scores immediately after consultation and to assess the decisional regret (DR) scores in the first 3 months following women's decision regarding termination of pregnancy. This quasi-experimental study was conducted during August 3rd-February 20th, 2016. We included 80 women whose fetuses were diagnosed with β-thalassemia major (β-TM) through chorionic villi sampling and were referred to the only prenatal diagnosis center at Ali-Asghar Hospital, Zahedan, Iran. While the control group went through the routine procedures, the intervention group received a 90-min counseling session based on SDM. The demographic characteristics form and DC scale were filled out immediately after the consultation session. After 3 months, the women were contacted via telephone call to collect data on their level of DR. The mean DC score was significantly (P = < 0.0025) lower in the intervention group (8.47 ± 4.63) compared with the control group (44.10 ± 14.5). Moreover, the mean score of DR was significantly (P = 0.004) lower in the intervention group (9.37 ± 15.44) compared with the control group (24.37 ± 23.42). SDM consultation can help women experience significantly lower levels of DC and DR.

Prenatal (non)treatment decisions in extreme prematurity: evaluation of Decisional Conflict and Regret among parents.

To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics. A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24+0/7-24+6/7 weeks gestational age in 2010-2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics. Sixty-one surveys were returned (response rate 27%). The median Decisional Conflict score was 28. From the subscores within Decisional Conflict, 'values clarity' revealed the highest median score of 42-revealing that parents felt unclear about personal values for benefits and risks of the decision on either comfort care or active care. The median Decision Regret score was 0. Regret scores were influenced by the actual decision made and by outcome: Decision Regret was lower in the active care group and in the survivor group. We found little Decisional Conflict and no Decision Regret among parents regarding decision-making at 24 weeks gestation.

Decisional conflict between treatment options among end-stage renal disease patients evaluated for kidney transplantation.

Although kidney transplantation provides a significant benefit over dialysis, many patients with end-stage renal disease (ESRD) are conflicted about their decision to undergo kidney transplant. We aimed to identify the prevalence and characteristics associated with decisional conflict between treatment options in ESRD patients presenting for transplant evaluation. Among a cross-sectional sample of patients with ESRD (n=464) surveyed in 2014 and 2015, we assessed decisional conflict through a validated 10-item questionnaire. Decisional conflict was dichotomized into no decisional conflict (score=0) and any decisional conflict (score>0). We investigated potential characteristics of patients with decisional conflict using bivariate and multivariable logistic regression. The overall mean age was 50.6years, with 62% male patients and 48% African American patients. Nearly half (48.5%) of patients had decisional conflict regarding treatment options. Characteristics significantly associated with decisional conflict in multivariable analysis included male sex, lower educational attainment, and less transplant knowledge. Understanding characteristics associated with decisional conflict in patients with ESRD could help identify patients who may benefit from targeted interventions to help patients make informed, value-based, and supported decisions when deciding how to best treat their kidney disease.

Use of a 17-Gene Prognostic Assay in Contemporary Urologic Practice: Results of an Interim Analysis in an Observational Cohort

To study the impact of genomic testing in shared decision making for men with clinically low-risk prostate cancer (PCa). Patients with clinically low-risk PCa were enrolled in a prospective, multi-institutional study of a validated 17-gene tissue-based reverse transcription polymerase chain reaction assay (Genomic Prostate Score [GPS]). In this paper we report on outcomes in the first 297 patients enrolled in the study with valid 17-gene assay results and decision-change data. The primary end points were shared decision on initial management and persistence on active surveillance (AS) at 1 year post diagnosis. AS utilization and persistence were compared with similar end points in a group of patients who did not have genomic testing (baseline cohort). Secondary end points included perceived utility of the assay and patient decisional conflict before and after testing. One-year results were available on 258 patients. Shift between initial recommendation and shared decision occurred in 23% of patients. Utilization of AS was higher in the GPS-tested cohort than in the untested baseline cohort (62% vs 40%). The proportion of men who selected and persisted on AS at 1 year was 55% and 34% in the GPS and baseline cohorts, respectively. Physicians reported that GPS was useful in 90% of cases. Mean decisional conflict scores declined in patients after GPS testing. Patients who received GPS testing were more likely to select and persist on AS for initial management compared with a matched baseline group. These data indicate that GPS help guide shared decisions in clinically low-risk PCa.

Field testing of decision coaching with a decision aid for parents facing extreme prematurity

The objective of this study is to assess and modify an existing decision aid and field-test decision coaching with the modified aid during consultations with parents facing potential delivery at 23 to 24 weeks gestation. International Patient Decision Aid Standards instrument (IPDASi) scoring deficits, multi-stakeholder group feedback and α-testing guided modifications. Feasibility/acceptability were assessed. The Decisional Conflict Scale was used to measure participants' decisional conflict before (T1) and immediately after (T2) the consultation. IPDASi assessment of the existing aid (score 11/35) indicated it required updated data, more information and a palliative care description. Following modification, IPDASi score increased to 26/35. Twenty subjects (12 pregnancies) participated in field-testing; 15 completed all questionnaires. Most participants (89%) would definitely recommend this form of consultation. Decisional conflict scores decreased (P<0.001) between T1 (52±25) and T2 (10±16). Field testing demonstrated that consultations using the aid with decision coaching were feasible, reduced decisional conflict and may facilitate shared decision-making.

Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s

BackgroundExpert groups and national guidelines recommend individualized decision making about screening mammography for women in their 40s at low-to-average risk of breast cancer. We created Breast Screening Decisions (BSD), a personalized, web-based decision aid, to help women decide when to start and how often to have routine screening mammograms. We evaluated BSD in a large, prospective pilot trial of women and their clinicians.MethodsWomen ages 40–49 were invited to use BSD before a scheduled preventive care visit. One month post-visit, users were asked about decisional conflict, knowledge, perceptions and worry about breast cancer and screening. They were also asked whether they had a screening mammogram since their visit, scheduled an appointment for a screening mammogram, or if they were planning to schedule an appointment within the next six months. Women who responded “no” to each of these successive questions were considered to have no plan for a screening mammogram within the next 6 months, unless they explicitly stated that they were unsure about screening mammography. Clinicians were surveyed regarding mammography discussions and perceived patient knowledge and anxiety.ResultsOf 1,100 women invited to use BSD, 253 accessed the website, and 168 were eligible to participate in the pilot study. One-fifth had a family history of breast cancer, and at least 76% had any prior mammogram. At follow-up, 88% of BSD users reported discussing mammography at their visit, and 77% said they had a screening mammogram since the visit or that they made or were planning to make a screening mammogram appointment. The average decisional conflict score was 22.5, within the threshold for implementing decisions. Decisional conflict scores were lowest in women who said that they had or planned to have a mammogram (mean 21.4, 95% CI 18.3-24.6), higher in those who did not (mean 24.8, 95% CI 19.2-30.5), and highest in those who were unsure (mean 31.5, 95% CI 13.9-49.1). Most BSD users expressed accurate perceptions of their breast cancer risk and the benefits and limitations of screening.ConclusionsA web-based decision aid may support informed, individualized decisions about screening mammography and facilitate discussions about screening between women in their 40s and their clinicians.

High Levels of Decisional Conflict and Decision Regret When Making Decisions About Biologics.

The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.

Effect of decision aid for breast cancer prevention on decisional conflict in women with a BRCA1 or BRCA2 mutation: a multisite, randomized, controlled trial.

Women with a BRCA1 or BRCA2 mutation are at high risk for breast cancer and must make important decisions about breast cancer prevention and screening. In the current study, we report a multisite, randomized, controlled trial evaluating the effectiveness of a decision aid for breast cancer prevention in women with a BRCA mutation with no previous diagnosis of cancer. Within 1 month of receiving a positive BRCA result, women were randomized to receive either usual care (control group) or decision aid (intervention group). Participants were followed at 3, 6, and 12 months; were asked about preventive measures; and completed standardized questionnaires assessing decision making and psychosocial functioning. One hundred fifty women were randomized. Mean cancer-related distress scores were significantly lower in the intervention group compared with the control group at 6 months (P = 0.01) and at 12 months postrandomization (P = 0.05). Decisional conflict scores declined over time for both groups and at no time were there statistical differences between the two groups. The decision aid for breast cancer prevention in women with a BRCA1 or BRCA2 mutation is effective in significantly decreasing cancer-related distress within the year following receipt of positive genetic test results.Genet Med 19 3, 330-336.

Development and validation of a decision aid for choosing among antithrombotic agents for atrial fibrillation

BackgroundMultiple antithrombotic agents are available for stroke prevention in atrial fibrillation (AF). A decision aid can assist patients in making informed decisions that best serves their needs. ObjectiveTo validate a decision aid to assist patients in choosing between antithrombotic agents (antiplatelets, warfarin, direct-acting oral anticoagulants (DOACs)) for AF. MethodsPatients (60years or older) were recruited for this prospective study. The decision aid presented descriptions related to AF, then charts portraying important outcomes for comparisons between 1) no treatment, aspirin and anticoagulants, 2) warfarin versus DOACs, and 3) DOAC versus DOAC. The primary outcome was confidence in making treatment decisions. The secondary outcomes included change in knowledge scores, ratings of clarity, helpfulness and comprehensiveness. ResultsEighty-one patients (mean age 75.2 [SD 7.5], 77% taking an anticoagulant) participated. After using the decision aid, mean decisional conflict score was low at 7.2 [SD 10.8] on a scale from 1 to 100. Mean knowledge score (total possible 10) improved from 7.4 [SD 1.7] to 9.3 [SD 1.0] (p<0.001). The mean helpfulness score in making a treatment choice was high at 6.2 [SD 0.9] on a scale from 1 to 7. No participant found the decision aid difficult to understand. Information in the decision aid was rated as good or excellent in terms of clarity and comprehensiveness. ConclusionsOur decision aid addresses a key medication safety gap – assisting patients to participate in shared decisions about anticoagulation. Future research is required to evaluate how decision aids influence actual choices and clinical outcomes.

Parental decision making in pediatric otoplasty: The role of shared decision making in parental decisional conflict and decisional regret.

To date, there has been little research on shared decision making and decisional outcomes in pediatric surgery. The objectives of this study were to describe the level of decisional conflict and decisional regret experienced by parents considering otoplasty for their children, and to determine if they are related to perceptions of shared decision making. Prospective cohort clinical study. Sixty-five consecutive parents of children who underwent surgical consultation for otoplasty were prospectively enrolled. Participants completed the Demographic Form, the Decisional Conflict Scale, and the Shared Decision-Making Questionnaire after the consultation visit. The consulting surgeons completed the physician version of the Shared Decision-Making Questionnaire. Six months after surgery, parents completed the Decisional Regret Scale. The median decisional conflict was 15.63; 21 (32.8%) parents scored 25 or above, a previously defined cutoff indicating clinically significant decisional conflict. Parent ratings of shared decision making and decisional conflict were significantly negatively correlated (P < 0.001); however, there was no significant correlation between physician ratings of shared decision making and parental decisional conflict. Significant decisional regret was reported in two (3.2%) participants. Decisional regret and parent and physician ratings of shared decision making were both significantly negatively correlated (P = 0.044 and P = 0.001, respectively). Decisional regret and decisional conflict scores were significantly positively correlated (P = 0.001). Parent and physician ratings of shared decision making were correlated (intraclass correlation = 0.625, P < 0.001). Many parents experienced significant decisional conflict when making decisions about their child's elective surgical treatment. Fewer parents experienced significant decisional regret after the procedure. Parents who perceived themselves as being more involved in the decision making process reported less decisional conflict and decisional regret. Parents and physicians had varied perceptions of the degree of shared decision making. Future research should develop interventions to increase parents' involvement in decision making and explore the influence of significant decisional conflict and decisional regret on health outcomes. 2b. Laryngoscope, 126:S5-S13, 2016.

MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER?

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-09 DOES A CLEAR UNDERSTANDING OF LIFE EXPECTANCY INCREASE DECISIONAL CONFLICT AND ANXIETY FOR MEN WITH NEWLY DIAGNOSED PROSTATE CANCER? Mazen Alsinnawi, April E. Slee, John S. Banerji, Kathryn L. Dahl, Sydney Akapame, John D Massman III, Erika M. Wolff, and John M. Corman Mazen AlsinnawiMazen Alsinnawi More articles by this author , April E. SleeApril E. Slee More articles by this author , John S. BanerjiJohn S. Banerji More articles by this author , Kathryn L. DahlKathryn L. Dahl More articles by this author , Sydney AkapameSydney Akapame More articles by this author , John D Massman IIIJohn D Massman III More articles by this author , Erika M. WolffErika M. Wolff More articles by this author , and John M. CormanJohn M. Corman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (CaP) decision making is complicated by multiple treatment choices with implications for survival and quality of life. Although knowledge of the effect of co-morbidities on life expectancy helps clinicians to determine the range of treatment options available for their patients, patients are not usually, explicitly given this information. We utilized the Charlson Comorbidity Index (CCI) to predict life expectancy in men with newly diagnosed CaP. The objective of this study is to determine whether providing patients with their CCI score increases treatment decisional conflict and anxiety about death. METHODS Patients with newly diagnosed CaP were randomized to receive standard multidisciplinary care versus the same counseling with the addition of the patient's prospective understanding of his CCI score. Patients subsequently completed the Decisional Conflict Scale (DCS) and the Death Anxiety Scale (DAS). The primary objective was to determine whether telling patients their life expectancy complicated their treatment decisions and increased their anxiety levels. Five percent non inferiority margin was used for both instruments. Because the primary hypothesis was safety, patients were analyzed according to the intervention they received. RESULTS A total of 228 patients returned surveys, 123 received standard counselling and 105 were prospectively informed of their CCI. Mean age was 65 years. 17% had high risk CaP and the median 10-year survival probability was 80.9%. There was no statistical significant difference in planned treatment choice (active surveillance vs active treatment).18.7 % of the standard counselling group reported significant decisional conflict (> 37.5 points) compared to 10.5 % in the CCI group (p=0.08). Those who received CCI counseling had a mean decisional conflict score of 19.4, compared to 22.1 for the standard group. The difference between these was on average -2.7 points (95% CI -6.8, 1.3) which excludes the 5 % non-inferiority margin (range 0-100). The difference for DAS was -0.24 (95% CI, -1.08, 0.60) which excludes the 5 % margin (range 0-15). CONCLUSIONS Knowledge of CCI does not increase decisional conflict or anxiety about death, and may reduce the incidence of significant conflict. As we embrace the concept of shared decision making in urology, it is expected that the full disclosure of life expectancy will be standard of care. This study suggest that this disclosure can be made without contributing to patient stress and anxiety. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e31 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mazen Alsinnawi More articles by this author April E. Slee More articles by this author John S. Banerji More articles by this author Kathryn L. Dahl More articles by this author Sydney Akapame More articles by this author John D Massman III More articles by this author Erika M. Wolff More articles by this author John M. Corman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP25-02 DECISIONAL QUALITY IN PATIENTS WITH SMALL RENAL MASSES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I1 Apr 2016MP25-02 DECISIONAL QUALITY IN PATIENTS WITH SMALL RENAL MASSES Joseph Shirk, Aaron Laviana, Sylvia Lambrechts, Lorna Kwan, Amit Sumal, and Christopher Saigal Joseph ShirkJoseph Shirk More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Sylvia LambrechtsSylvia Lambrechts More articles by this author , Lorna KwanLorna Kwan More articles by this author , Amit SumalAmit Sumal More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.779AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment options for patients diagnosed with small renal masses are proliferating, and the optimal choice for any one patient may depend on her personal preferences. Decades of research on “shared decision-making” have demonstrated that patients who make preference-sensitive decisions in a collaborative, evidence-based manner with their physicians tend to have higher decisional quality. We measured current decisional quality in patients being counseled at a referral center for small renal masses to identify areas of improvement to be addressed in the future by a shared decision making program. METHODS We evaluated measures of decisional quality such as decisional conflict, patient satisfaction with care, disease specific knowledge, and patient impression that shared decision-making occurred in the visit. 56 patients diagnosed with renal masses at the Ronald Reagan UCLA Medical Center completed a decisional quality instrument after counseling by a specialist. These measures were then compared using Student's t-test. RESULTS Patients were mostly older (mean age 64.2), white (79%), in a relationship (55%) and unemployed/retired (57%). Average ± SD knowledge scores were 59 ± 19%. The average ± SD decisional conflict score was 16.5 ± 19.6, signifying low levels of decisional conflict but with a wide range of scores. Comparing patients with high decisional conflict to low decisional conflict, there was a significant difference in knowledge scores (p= 0.0024), patient satisfaction with care (p=0.0165) and perceived shared decision making (p= <0.0001)(Figure). 48% of patients were unsure about their treatment, and 20% of these patients remained unsure after counselling. CONCLUSIONS Patients with small renal masses generally have low levels of decisional conflict and are able to identify a preferred treatment after a physician visit. However, both groups lack overall knowledge about their disease even after counselling, and thus may be heavily influenced by paternalistic care. Those with decisional conflict are less likely to perceive their care as satisfactory and are less likely to be involved in decision making. Implementation of a shared decision making program in this setting may improve decisional quality for these patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e278-e279 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Joseph Shirk More articles by this author Aaron Laviana More articles by this author Sylvia Lambrechts More articles by this author Lorna Kwan More articles by this author Amit Sumal More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract A15: How does doctor-patient communication about prostate cancer screening influence African-American patients' decisional conflict around screening decisions?

Abstract Background: Decisional conflict is the state of uncertainty about the course of action to take. The decisional conflict scale measures personal perceptions of uncertainty in choosing options. Because experts in the medical community disagree about whether men should get screened for prostate cancer, the decision to get screened is often less certain than that for other tests. In order to make the best decisions about prostate cancer screening, patients must be well-informed of both the risks and benefits of screening. In this study, we assessed whether talking to a doctor about risks and benefits was associated with decisional conflict. Methods: A total of 86 African-American men recruited in community-based and faith-based settings completed a baseline survey as part of a prostate cancer education program. The survey incorporated a revised version of the Decisional Conflict Scale. Participants responded “yes”, “unsure” or “no”, and these were scored as 1, 2, and 3 respectively. Scores for each of 10 items were averaged to obtain a decisional conflict score. The survey also included demographic information, questions about participants' experiences with prostate cancer screening, questions about past communication with physicians about screening, knowledge about prostate cancer, and health practices. All responses were self-reported. After the survey, participants took part in an in-depth prostate cancer information session lead by a physician or a community health worker. For this study, analyses were limited to responses from the baseline survey. Results: The demographics of this sample include African American males of mean age 57.8 (sd 12.4), the majority of whom have at least some college education (72.0%). Most participants completed prostate cancer screening in the past year (57.4%). Half of the men completed a PSA test in the past year (49.4%), and 41% completed DRE. The majority of participants had discussed prostate cancer screening with their doctors (75.6%), and had discussed the benefits of screening with their doctors (67.4%). However, less than half (44.2%) had discussed the risks of prostate cancer screening with their doctors, and even fewer had doctors who informed them that experts disagree about whether men should have a PSA test (26.7%). We found that decisional conflict was negatively associated with having a previous PSA test (β=-0.378, p=0.007), having a doctor who talked with the participant about the benefits of testing (β=-0.424, p=0.002), having a doctor who talked with the participant about the risks of participating (β=-0.392, p=0.001), and with having a doctor who informed them that experts disagree on the need for PSA testing (β=-0.601, p&amp;lt;0.001). No association was found between having a previous DRE and decisional conflict. All associations remained significant after adjusting for age and education. Conclusions: Well-informed patients experience lower decisional conflict. While few participants discussed risks or the lack of consensus about whether men should be screened with their doctors, we found that discussing the risks and disagreement about testing, in addition to the benefits of testing, were significantly associated with having lower decisional conflict scores compared to those who had not had such conversations with their doctors. In addition, previous PSA testing was associated with lower decisional conflict. These results suggest that, to facilitate better decisions about this controversial topic among black men, doctors should consider more open discussion about prostate cancer screening, and that they include the risks, benefits, and controversies in their conversations with patients. Citation Format: Michael Fenstermaker, Theodore Hickman, Heather Gold, Danil Makarov, Stacy Loeb, Helen Cole, Elizabeth Cahn, Joseph Ravenell. How does doctor-patient communication about prostate cancer screening influence African-American patients' decisional conflict around screening decisions? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A15.

Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict

BackgroundPatients with type 2 diabetes (T2DM) often have poor glycemic control on first-line pharmacologic therapy and require treatment intensification. Intensification decisions can be difficult because of many available options and their many benefits and risks. The American Diabetes Association recommends patient-centered, evidence-based tools supporting shared decision-making between patients and clinicians. We developed a patient decision aid (PDA) targeting decisions about treatment intensification for T2DM. Our objective was to determine the effectiveness of this PDA for patients with T2DM on metformin who require treatment intensification.MethodsThis study was a pragmatic randomized controlled trial conducted in 27 US primary care and endocrinology clinics. Subjects were English-speaking adults with T2DM receiving metformin with persistent hyperglycemia who were recommended to consider medication intensification. Subjects were randomized to receive either the PDA or usual care (UC). Main outcome measures were change in knowledge, decisional self-efficacy, and decisional conflict.ResultsOf 225 subjects enrolled, 114 were randomized to the PDA and 111 to UC. Mean [SD] age was 52 [1] years, time since T2DM diagnosis was 6 [+/−6] years, 45.3 % were male, and most (55.5 %) were non-Caucasian. Compared to UC, PDA users had significantly larger knowledge gains (35.0 % [22.3] vs 9.9 % [22.2]; P < 0.0001) and larger improvements in self-efficacy (3.7 [16.7] vs−3.9 [19.2]; P < 0.0001) and decisional conflict (−22.2 [20.6] vs−7.5 [16.6]; P < 0.0001).ConclusionsThe PDA resulted in substantial and significant improvements in knowledge, decisional conflict and decisional self-efficacy. Decisional conflict scores after PDA use were within the range that correlates with effective decision-making. This PDA has the potential to facilitate shared-decision-making for patients with T2DM.Trial registration NCT02110979 Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1262-4) contains supplementary material, which is available to authorized users.

The Effect of Counseling on Cataract Patient Knowledge, Decisional Conflict, and Satisfaction

Purpose: Cataract is the leading cause of non-refractive preventable blindness, and comprehensive strategies to increase cataract surgery rates are imperative, including high-quality supportive patient education. We evaluated the effectiveness of non-physician pre-surgical counselors teaching patients about cataract and cataract surgery in improving patient knowledge, decisional conflict, and satisfaction.Methods: A survey was given before and after 61 newly-diagnosed cataract patients underwent pre-surgical counseling at the Aravind Eye Hospital, Madurai, India. The survey measured change in cataract knowledge and decisional conflict, a measure of anxiety surrounding the decision to undergo surgery, along with patient satisfaction. Multiple regression was used to identify factors that influenced change in knowledge.Results: Both patient knowledge scores and decisional conflict scores improved following counseling (mean difference +2.0, p = 0.004 and +8.4, p < 0.0001, respectively). Multiple regression analysis identified female sex (β = 2.5, p < 0.001) and being illiterate (β = 1.7, p = 0.04) as important predictors of increased knowledge post-counseling.Conclusion: Counseling both improved knowledge and reduced decisional conflict about cataract surgery, particularly among patients who had traditionally had more limited access to healthcare such as women and illiterate patients. Increased use of high quality counseling might help to further reduce the global burden of cataract and other forms of blindness.

Decisional conflict in asthma patients: a cross sectional study

Objective: This study aimed at determining the level of decisional conflict in asthmatic individuals facing recommendation-based decisions provided to improve asthma control. Methods: This was a cross-sectional study performed on a convenience sample of 50 adults aged between 18 and 65 years with a diagnosis of asthma. They completed a decisional conflict scale (possible range of 0–100%), asthma knowledge and control questionnaires (both 0% and 100%), and a general questionnaire on socio-demographic characteristics. A decisional conflict was considered clinically significant with a score greater than 37.5%. Simple descriptive statistics were used to investigate associations with decisional conflict. Results: Participants were mainly women (76%) and diagnosed with mild asthma (72%). The median age (1st and 3rd quartile) was 25 years (22 and 42). The median score (1st and 3rd quartile) of decisional conflict was 33% (24 and 44). A clinically significant score (>37.5%) was obtained in 36% of subjects. A statistically significant negative correlation between the knowledge score and the decisional conflict score (rp = −0.38; p = 0.006) was observed. The level of knowledge was the only statistically independent variable associated with the decisional conflict score (p = 0.0043). Conclusions: A considerable proportion of patients with asthma have a clinically significant level of decisional conflict when facing decisions aimed at improving asthma control. Patients with poor knowledge of asthma are more at risk of clinically significant level of decisional conflict. These findings support the relevance of providing asthmatic patients with relevant information in decision aids.