Emergency Nurses' Experiences of Triaging Geriatric Trauma Patients: A Qualitative Study.

Women with a prior cesarean section frequently face challenges in choosing the mode of delivery, and limited knowledge, negative attitudes toward vaginal birth, and lack of tailored guidance often led to elective repeat cesarean sections. The main objective of this study is to design, develop, and evaluate a web-based counseling system to support and empower pregnant women in making informed decisions regarding vaginal birth after cesarean (VBAC). A sequential exploratory mixed-methods study will be conducted in Mashhad, Iran. Phase 1 (qualitative) will use conventional content analysis of semi-structured interviews with 25 pregnant women and healthcare providers to identify needs, expectations, and preferences for a web-based VBAC counseling system. Phase 2 will involve iterative prototype development following the prototyping model, guided by qualitative findings, expert validation, and a systematic review. Phase 3 will evaluate system usability (System Usability Scale) and effectiveness via a two-arm randomized controlled trial with 80 eligible women. Districts will be randomized; intervention participants will access the web-based system, while controls receive routine care. Primary outcomes are VBAC intention, choices, and VBAC actual rates. Secondary outcomes include knowledge, satisfaction, and breastfeeding success. Data will be analyzed using SPSS. This study examines the impact of a web-based VBAC counseling system on empowering pregnant women by enhancing their knowledge of delivery options and reducing decisional conflict. The system is designed to support informed decision-making, promote shared decision-making with healthcare providers, and facilitate safer, evidence-based choices regarding vaginal birth after cesarean. This trial is registered with the Iranian Registry of Clinical Trials under registration number IRCT20170607034378N3, with the registration date 2025-11-15.

Open partial horizontal laryngectomy (OPHL) is a key conservative option for laryngeal cancer, with established oncological outcomes but limited data on functional results and patient perspectives. Voice preservation is mainly associated with type I OPHL, whereas types II-III often result in significant but broadly comparable impairments, making vocal decline the main limitation of OPHL. Patient-reported outcomes (PROs) help clarify the balance between treatment efficacy and side effects. This single-institution study analyzed 70 consecutive OPHL patients (12 women, 17.1%; 58 men, 82.9%), mean age 65.9 years (SD 8.96), with a median follow-up of 52.5 months (range 2-218). PROs were assessed using the Priority Scale, the V-RQOL, the MDADI, the Decisional Conflict Scale, the Decisional Regret Scale, and the Brief Pain Inventory. The Priority Scale showed that curing cancer (98.6%) and prolonging life (82.9%) were top concerns, while only 34.3% prioritized natural voice preservation. V-RQOL averaged 77.4/100, indicating limited impact of voice on quality of life; MDADI was 78.5/100, reflecting minimal swallowing difficulties. Decisional Conflict averaged 34.3/100, with 30% reporting no difficulty; Decisional Regret was low (13.0/100), with only 1.4% expressing moderate regret. Most patients (78.6%) reported no pain. Overall, OPHL provided satisfactory functional and decisional outcomes, with high patient satisfaction despite the complexity of treatment.

Objective: To investigate the current status of perceived partner responsiveness among married breast cancer patients and their spouses, and to analyze their effects on patients’ decisional conflict. Methods: Using convenience sampling, a total of 121 pairs of married breast cancer inpatients and their spouses were recruited from a tertiary specialized hospital in Zhejiang Province between December 2023 and November 2024. Data were collected with a general information questionnaire, the Perceived Partner Responsiveness Scale, and the Decisional Conflict Scale (DCS). Categorical data were described using frequencies and percentages, while continuous data were presented as mean ± standard deviation. Paired-sample t-tests were employed to compare differences in perceived partner responsiveness between couples. Pearson correlation analysis was conducted to examine the relationships between both partners’ perceived responsiveness and patient decisional conflict. With patient decisional conflict as the dependent variable, a multiple linear regression model was constructed, incorporating both patient- and spouse-perceived partner responsiveness to analyze their impact on patient decisional conflict. Results: Out of 160 questionnaires distributed, 121 valid questionnaires were returned, yielding an effective response rate of 75.63%. Spouses reported significantly higher levels of perceived partner responsiveness than patients, and the difference was statistically significant (P < 0.001). Perceived partner responsiveness reported by both patients and spouses was negatively correlated with patient decisional conflict (P < 0.001). Multiple linear regression analysis revealed that marital duration, education level, implant reconstruction, and patient-perceived partner responsiveness were independent influencing factors of decisional conflict in married breast cancer patients (P < 0.05). Conclusion: Perceived partner responsiveness in both breast cancer patients and their spouses is closely associated with the level of decisional conflict perceived by the patient. Therefore, implementing decision support interventions developed based on both spouses may be more effective in reducing patients’ decisional conflict.

To identify predictors of decisional conflict among women with a BRCA pathogenic variant (PV) who were eligible for risk reducing salpingo-oophorectomy (RRSO) who had not made a decision to have surgery at least one year after receiving genetic test results. Women with a BRCA1 or BRCA2 PV between the ages of 35 and 70 years old, who had not elected for RRSO at least 12 months after receipt of genetic test results, were administered self-report questionnaires investigating demographic variables, decisional conflict (Decisional Conflict Scale), cancer-related distress (Impact of Event Scale) and cancer risk perception. Decisional conflict scores were generated and a multivariable linear regression was conducted to identify variables associated with decisional conflict. A sample of 107 women completed questionnaires. Overall, 44 participants (41%) had a high decisional conflict score (greater than 37.5) related to the RRSO decision. Higher education (β = 11.40, 95% C.I: 0.59, 22.20; p = 0.039), non-white race (β = 11.12, 95% C.I: 0.66, 21.57; p = 0.037), and having children (β = 22.89, 95% C.I: 10.07, 35.71; p < 0.001) were significantly associated with higher decisional conflict. Lower decisional conflict was significantly associated with genetic testing more than 3 years prior (β = -13.14, 95% C.I: -23.27, -2.99; p = 0.012). Many women with a BRCA PV who have not elected for RRSO are experiencing high levels of decisional conflict related to the decision regarding RRSO. Interventions that target decisional conflict are needed to increase the uptake of RRSO which will result in a reduction of the risk of ovarian cancer in women with BRCA1 or BRCA2 PV.

BackgroundShared decision-making is increasingly valued worldwide in pediatric care; nonetheless, its application in Japanese clinical practice remains in its early stages, particularly in areas with substantial medical uncertainty, such as food allergy (FA) management. Although oral immunotherapy is a promising option for children with FA, its long-term effectiveness and safety remain under evaluation, providing families with limited evidence to navigate emotionally complex decisions. Despite this clinical uncertainty, decision aids (DAs) are beneficial for organizing information and supporting patients and families in making value-congruent choices. Involving children in these decisions is increasingly recognized as ethically and developmentally appropriate. DAs clarify treatment options and promote informed collaborative decisions. However, most DAs target adult users and do not explicitly encourage engagement with children’s views.ObjectiveThis study aimed to develop a culturally adapted DA for Japanese parents by considering their children’s preferences and perspectives.MethodsA paper-based DA was developed through iterative alpha testing and finalized by a multidisciplinary team. In total, 9 parents of children eligible for oral immunotherapy participated in this study and received the DA. Although intended for parents, the DA was structured to prompt reflection on the children’s involvement in decision-making. Parents completed structured questionnaires before and 1 week after receiving the DA to assess uncertainty, anxiety, and the burden of FA management. A total of 4 children completed the quality-of-life (QoL) questionnaire. Subsequently, all 9 parents and 4 children participated in semistructured interviews. Parents discussed how they used the DA, their perceptions of its clarity, and their interest in involving their children in decision-making. The children shared their thoughts about participating in decision-making.ResultsAll 9 parents read the DA and completed the follow-up assessment (100% retention rate). Among them, 4 children participated in pediatric QoL assessments and interviews. Parents’ Decisional Conflict Scale scores significantly decreased from 58.3 (SD 29.9) at baseline to 26.7 (SD 24.1) postintervention (t8=2.65; P=.03). The values clarity subscale also significantly declined, from 73.1 (SD 30.6) to 25.9 (SD 26.2) (t8=4.50; P=.002). No significant changes were observed in parental anxiety and QoL. Overall, 7 of the 9 parents explained the treatment options to their child, and 6 reported actively seeking their child’s feelings. The interview results suggested that the DA was associated with a shift in the family dynamic “from protecting to partnering.”ConclusionsCulturally adapted DAs appear practical and acceptable to Japanese families when making pediatric FA treatment choices. Facilitating parent-child dialogue may promote more inclusive decision-making. Nevertheless, further research with larger samples and longer follow-up periods is warranted to confirm these findings and refine the tool.

Managing head and neck squamous cell carcinoma (HNSCC) involves complex decision-making, requiring a balance between optimizing prognosis and preserving quality of life. However, the role of individualized prognostic counseling in the decision-making process is not well known. To assess the association of individualized prognostic counseling with the decision-making process in patients with primary HNSCC. This prospective nonrandomized clinical trial with sequential cohorts was conducted at an academic tertiary referral center. Patients with newly diagnosed primary HNSCC who were eligible for curative treatment were enrolled between January 2014 and August 2018 (cohort 1; standard) and between October 2019 and January 2022 (cohort 2; intervention). Data were analyzed between January and August 2023. Cohort 1 received standard counseling from the treating physician, while cohort 2 received additional individualized prognostic counseling through an online prognostic model. Both cohorts were divided into small laryngeal squamous cell carcinoma (SLSCC) and other HNSCC groups. The primary outcome was decisional conflict, measured using the Decisional Conflict Scale. Secondary outcomes included perceived role in decision-making (Control Preferences Scale), decisional regret, treatment choice, and quality of life. A total of 458 patients were enrolled (258 in cohort 1 and 200 in cohort 2; mean [SD] age, 66.1 [8.8] years; 79% [362 of 458] men). Decisional conflict was lower following individualized prognostic counseling for both SLSCC (Cohen d = 0.19; 95% CI, -0.10 to 0.49) and other HNSCC groups (Cohen d = 0.34; 95% CI, 0.10-0.58). Among patients with other HNSCC, the largest and most precise effect sizes were seen in the informed, values clarity, and support subscales of the Decisional Conflict Scale. Decisional regret was lower at 3 to 6 months after individualized counseling (cohort 2 median, 5 [IQR. 0-20] and cohort 1 median, 20 [IQR, 1-29]; rank-biserial r = 0.15 for SLSCC; cohort 2 median, 10 [IQR. 0-20] and cohort 1 median, 20 [IQR, 10-25]; rank-biserial r = 0.29 for other HNSCC), indicating small to moderate improvements. These differences were minimal at 12 months. An association between individualized counseling and more active or shared decision-making roles was observed in the other HNSCC group (Cramer V = 0.21). No relevant differences in quality-of-life outcomes were identified. This nonrandomized clinical trial found that individualized prognostic counseling with an online prognostic model was associated with improvements in decisional conflict and decisional regret and promoted a more active and shared decision-making role among patients with head and neck cancer. The findings suggest integrating individualized prognostic information into routine consultations may enhance patient engagement, strengthen shared decision-making, and reduce uncertainty in complex treatment choices. Dutch Trial Register: NTR4106.

Shared Decision-Making in Curative Uro-Oncology: A Systematic Review.

This study aimed to explore the experience of decision conflict among surrogate decision-makers for patients with critical illness undergoing neurosurgery. A qualitative descriptive research design was used. Participants were selected using a purposive sampling method, and semi-structured interviews were conducted to collect data, which were then analysed using Colaizzi's seven-step analysis method. The study was conducted in a tertiary hospital in China. This study included 15 surrogate decision-makers for patients with critical illness undergoing neurosurgery as interview participants. In this interview study, two main themes and nine subthemes were identified：(a) core conflict in the decision-making process: conflicts between the quality of life and the length of life, conflict between patient and surrogate preferences and conflict between the expected and realistic treatment outcomes; and (b) complex causes of decisional conflict: the burden of decision-making in critical care, inadequate decision-making information, erosion of patient-physician trust, socio-cultural pressures, overwhelming financial burden and negative emotional distress. Surrogate decision-makers for patients with neurological critical illness often experience complex decision conflicts during the clinical decision-making process. This underscores the need for healthcare providers to identify high-risk individuals for decision conflicts early on and provide personalised decision support strategies to mitigate such conflicts and enhance decision quality.

High-risk mothers undergoing BRCA testing must decide whether, when, and how to disclose hereditary cancer risk information to their adolescent and young adult (AYA) children. This study explored maternal preferences/values and cognitive-affective factors influencing these decisions during genetic counseling. Mothers (N=282) reported on the perceived risks/benefits of AYA disclosure. Multivariable regression identified predictors of disclosure, and paired t-tests evaluated changes over time in maternal-AYA communication, distress, and decisional conflict following genetic counseling. Mothers reported valuing the benefits of disclosure more than risks (p<0.001). Those who valued disclosure tended to have female (t=-1.74, p=0.08) and older (r=0.14, p=0.03) children but were less knowledgeable about cancer risk (r=-0.17, p=0.005). Conversely, mothers who perceived disclosure to AYAs as riskier tended to be non-white (t=1.80, p=0.072), Hispanic (t=1.66, p=0.098), lower-income (t=2.56, p=0.011), and with younger children (r=-0.28, p<0.001) in poorer mental health (r=0.12, p=0.047). These findings were reaffirmed though a multivariable regression model controlling for benefits (adjusted R2=0.11; age B=-1.09, p<0.001; mental health B=0.36, p=0.04). Post-counseling, participants showed reduced decisional conflict (t=2.4, p=0.009) but increased depression/anxiety (t=-1.4, p=0.08) and lower parent-child relationship quality (t=2.7, p<0.001). Clinicians should be attuned to the factors shaping parental disclosure decisions and consider offering additional support to manage distress. Tailored educational tools for parents may aid family communication and improve psychosocial outcomes alongside genetic counseling.

A mixed methods systematic review of cancer treatment decision-making in vulnerable populations.

P0427 Intestinal ultrasound for the detection of postoperative recurrence in Crohn’s disease: a systematic review and meta-analysis

Chronic kidney disease (CKD) patients often struggle to balance the risks and benefits of their treatment options, leading to dilemma in decision-making process. Shared decision-making (SDM) is considered as the cornerstone of patient-centered care by engaging patients in treatment choices across various chronic diseases, including CKD. This review explores the significance of SDM in CKD care and highlights the barriers to its implication. This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses-scoping reviews guidelines. Literature search was conducted using Scopus, ProQuest, and PubMed databases. Out of the initially searched 18742 articles, 20 articles are included in this review. The findings revealed that SDM improved patient engagement, self-efficacy, and reduced decisional conflict in CKD management. However, barriers such as limited health literacy, disease-knowledge gaps, and inadequate communication hindered effective decision-making. In addition, social, demographic, and psychosocial factors influenced self-care behaviors and treatment choices. Despite the potential benefits, many CKD patients do not experience SDM due to inadequate information and time constraints. Educating patients and training healthcare professionals are crucial steps for improving SDM practice in CKD care. Future studies should explore patient-clinician interaction and focus on the effects of culture and ethnicity on decision-making for effective treatment.

ImportanceSeveral feasible management options exist for indeterminate thyroid nodules (ITNs), which can lead to decisional conflict (DC) and uncertainty in patients.ObjectiveTo investigate patient and physician participation in shared decision-making (SDM) during the management of ITNs and the association of SDM with patient-perceived DC.Study DesignMulti-institutional, cross-sectional, multiple methods study.SettingThe Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from October 2020 to June 2023 and The Ottawa Hospital (Ottawa, Ontario) from November 2022 to June 2023.Intervention and ExposuresPatients with ITNs scheduled for an initial surgical consultation with an Otolaryngologist were included. Consultations were video-recorded using discreet cameras within clinic rooms at both sites. Management options discussed at both sites included repeat fine needle aspiration biopsy, ultrasound surveillance, surgery, and molecular testing.Main Outcome MeasuresPatient-perceived SDM was measured by the SDM Questionnaire-9 (SDM-Q-9) and perceived DC by the DC Scale (DCS). Surgeons’ perceptions of SDM were measured by the SDM-Q-Doc. Observer-determined SDM was reported using the multifocal approach to sharing in SDM (MAPPIN’SDM) instrument.ResultsSeventy-seven patients and 6 surgeons were included. Patient-perceived SDM was high [mean = 94.38, standard deviation (SD) = 7.61], while physician-perceived SDM was lower in comparison (mean = 83.21, SD = 9.14). Observer-determined SDM involvement of the patient (mean = 0.73, SD = 1.08), physician (mean = 1.71, SD = 1.33), and patient-physician dyad (mean = 1.75, SD = 1.27) was low. Clinically significant DC (DCS score ≥25) was reported by 13.2% of patients. There was a medium negative correlation between patient-perceived SDM involvement and DC (Pearson r = −0.311, P = 0.008). Patient-perceived SDM did not differ by clinicodemographic factors.ConclusionWhile patients and physicians perceived high levels of SDM, patients with ITNs are faced with difficult management decisions leading to DC.RelevanceThese findings highlight the need for developing decision-aids to support SDM and reduce DC in the management of ITNs.

BackgroundIndividuals living with stage 4 chronic kidney disease and their caregivers face multiple health-related decisions as the disease progresses. The ImPart (Improving the decision-making PARTnership of chronic kidney disease dyads), community-informed, factorial pilot trial intervention aims to train members of the dyad in skills to enhance decision support for patients.MethodsThis single-site pilot 23 factorial trial aims to evaluate the feasibility, acceptability, and preliminary efficacy of the ImPart decision-support training intervention components for individuals with stage 4 chronic kidney disease and their caregivers. Caregivers (n = 64) and patients (n = 64) will be randomly assigned to one of 8 combinations of 3 components with two levels each: (1) caregiver coaching on effective decision support (1 session vs. 3 sessions); (2) caregiver decision support communication training (1 session vs. no session); and (3) patient social support effectiveness psychoeducation (2 sessions vs. no sessions). The primary outcomes of this pilot study are feasibility and acceptability. Secondary outcomes will also be evaluated, including patient decision conflict, quality of life, patient and caregiver distress, and dyadic coping. Results will be used to create a version of ImPart for use in a future fully powered randomized controlled trial.DiscussionThis protocol outlines a pilot factorial trial, guided by the multiphase optimization strategy, to evaluate a community-engaged, co-developed decision-support intervention for individuals with stage 4 chronic kidney disease and their caregivers.Trial registrationNCT 06173323.

BackgroundInformal caregivers play a critical role in supporting people with dementia nearing the end of life and are at risk of stress, burden and depression. Despite this, evidence gaps exist on the optimal interventions for caregivers. This meta‐review aimed to identify, appraise and synthesise evidence on interventions designed to improve the quality of life of informal caregivers.MethodEpistemonikos, MEDLINE, and ASSIA were searched for reviews published between 1980 and April 2024. Quality was assessed using AMSTAR 2, and a narrative synthesis was performed. Analysis was conducted through a palliative care lens and involved charting concepts and components of dementia palliative care to caregiver interventions. Outcomes were then categorised based on whether dementia care or palliative care was the main approach and then linked to intervention concepts and evidence strength. Implementation requirements were mapped to the Consolidated Framework for Implementation Research (CFIR), culminating in the development of a system‐based logic model.ResultTen systematic reviews, covering 138 primary studies with 4,000 participants were included. Seven reviews had palliative care as the main approach and three were dementia focused. Interventions were grouped into three categories: psychosocial, educational and decision‐making. These interventions aligned with almost all the identified key concepts of dementia palliative care, particularly holistic assessments, person‐centered care and education. Caregiver outcomes were identified and grouped into five categories: (1) psychosocial, (2) skills (3) relationships, (4) communication, and (5) care planning. Palliative care focused reviews emphasised communication and decision‐making, whereas dementia focused reviews were more concerned with skills and coping. Meta‐analyses supported educational interventions in reducing depression, and decision‐making aids in lowering decisional conflict. The overall evidence quality was low and the reported strategies for implementing interventions were limited. A logic model was developed which detailed the essential context, processes and outcomes for implementing integrated dementia palliative care.ConclusionIntegrated dementia palliative care for caregivers requires multifaceted interventions. Combining dementia care and palliative care approaches addresses the distinct yet complementary concepts of dementia palliative care, while also impacting a broader range of caregiver outcomes and offering a more holistic approach. Future research is required on developing standardised outcome measures, cost effectiveness and implementation.

Abstract The management of diverticulitis has evolved significantly, shifting away from a rigid recommendation for colectomy after a specific number of episodes toward a more individualized, patient-centered approach. Evidence demonstrates that observation for recurrent uncomplicated diverticulitis does not substantially increase the risk of complications, emergency surgery, or mortality, challenging prior paradigms and supporting a focus on improving quality of life. As such, current guidelines advocate for shared decision-making that incorporates patient preferences, symptom burden, and surgical risk. The decision to pursue colectomy remains highly preference-sensitive and must balance clinical evidence with individual values and goals. Despite the importance of shared decision-making in this clinical context, decisional conflict and decision regret remain prevalent, reflecting ongoing challenges in aligning care with patient expectations. Future efforts should prioritize the integration of shared decision-making into clinical workflows through decision support tools, individualized risk models, and enhanced clinician training to improve patient-centered outcomes and quality of care in diverticulitis.

Abstract Shared decision-making (SDM) is a cornerstone of patient-centered care, particularly in colorectal surgery where treatment decisions often involve complex tradeoffs. This review outlines the principles, benefits, and challenges of SDM in surgical contexts, emphasizing its role in aligning clinical decisions with patient values. SDM enhances patient knowledge, reduces decisional conflict and regret, and improves satisfaction and adherence. It also offers systemic benefits, including reduced preference-sensitive surgeries and potential cost savings. Despite its promise, barriers such as limited health literacy, time constraints, and clinician discomfort with uncertainty hinder implementation. The review highlights validated tools and frameworks for studying SDM and explores the evolving role of decision aids in colorectal cancer care. Future research should focus on pragmatic, mixed-methods trials, and integration of SDM metrics into clinical workflows. Advancing SDM in colorectal surgery requires sustained efforts in clinician training, patient engagement, and culturally sensitive communication strategies.

Abstract Low rectal cancer is surgically managed with one of two primary procedures: low anterior resection (LAR) or abdominoperineal resection (APR). Each procedure has a unique profile of potential complications, oncologic outcomes, and quality-of-life impacts. The acceptability of these outcomes is highly driven by patient values. Consequently, shared decision-making is essential to selecting the optimal procedure for each patient. Evidence has shown that patient decision aids (PtDAs) improve patient knowledge, reduce decisional conflict, and support value-congruent decisions. This review describes the development of a rectal cancer PtDA for the choice between LAR and APR. This PtDA was designed according to the International Patient Decision Aid Standards and Ottawa Decision Support Framework. Evaluation of this rectal cancer PtDA demonstrated increased patient knowledge, reduced decisional conflict, and enhanced patient preparedness for decision-making. Despite strong evidence for their utility, PtDAs remain underutilized. This review highlights key barriers in implementing PtDAs and proposes strategies to facilitate the effective integration of PtDAs into surgical practice.

Stress and urgency urinary incontinence (UI) significantly impact the quality of life of women worldwide. The complexity of treatment options calls for robust decision support tools to guide informed, patient-centered care. This scoping review maps best practices in the development, implementation, use, evaluation, and reported outcomes of patient decision aids (PDAs) for adult women with stress and/or urgency urinary incontinence. Complementary literature searches (2000-2024) were conducted between March 2023 and May 2024 using scientific databases and gray literature. The first focused on general PDA, the second on PDAs specific for women with stress and/or urgency UI. Selected documents were analyzed using standardized extraction grids; inter-rater agreement ensured validity. Fourteen literature reviews and six studies specifically about PDAs for women with stress and/or urgency UI were selected. PDAs were reported to improve patient knowledge, reduce decisional conflict, and support shared decision-making. Key facilitators of PDA development and implementation include involving patients and healthcare professionals, adapting tools for diverse needs, clinician training, clear guidelines, regular updates, and multiformat accessibility. Barriers include time constraints, limited access, comprehension difficulties, individual preferences, media influence, and organizational challenges. Addressing these factors through tailored design, improved access, and targeted training is important for successful adoption and implementation of PDAs in this context. PDAs represent a valuable tool for supporting decision-making for women with stress and/or urgency UI. Future research should address long-term outcomes, cost-effectiveness, and strategies to tailor PDAs to diverse patient needs, ultimately enhancing patient-centered care and adoption in practice.