Higher Levels Of Decisional Conflict Research Articles

Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study.

Decision-making for patients with a locally advanced laryngeal carcinoma (T3 and T4) is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision-making, and to identify possible associated factors. In this multicenter prospective cohort study, participants completed questionnaires on DC, level of shared decision-making (SDM), and a knowledge test directly after counseling and 6 months after treatment. Descriptive statistics and Spearman correlation tests were used to analyze the data. Directly after counseling, almost all participants (44/45; 98%) experienced Clinically Significant DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%) correct on the knowledge test. Questions related to radiotherapy were answered best (69%, SD 29%), whilst only 35% (SD 29%) of the questions related to laryngectomy were answered correctly. Patients' perceived level of SDM (scale 0-100) was 70 (mean, SD 16.2), and for physicians this was 70 (SD 1.7). Most patients with advanced larynx cancer experience high levels of DC. Low knowledge levels regarding treatment aspects indicate a need for better patient counseling. Level IV Laryngoscope, 2024.

Video-Based Decision Aids Improve Sleep Surgery Decision-Making: A Randomized Controlled Trial.

Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre-consultation video decision aids on patient DC and decision readiness. Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]-100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high-conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. Twenty-five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post-visit improvements in DC scores (post-consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision-making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High-conflict patients (n = 5) who reviewed pre-visit videos (intervention sub-group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high-conflict control patients. Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision-making process. 2 Laryngoscope, 134:2958-2963, 2024.

Decisional conflict and its determinants among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy: a cross-sectional study

Decisional conflict might occur during shared decision-making (SDM) because immunotherapy is a rather novel treatment option for patients with cancer. To explore the prevalence and severity of physical and psychological symptoms and the effort invested in SDM in relation to decisional conflict among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy. This was a cross-sectional survey study. The SURE version of the Decisional Conflict Scale was used to screen cancer patients’ decisional conflict status. Demographic or clinical characteristics, physical symptoms and psychological distress; efforts invested in the SDM process were also assessed as potential factors related to decisional conflict. One hundred seventeen patients surveyed, the prevalence of fatigue (79.5%), sleep disturbance (78.6%), poor appetite (67.5%), and pain (58.1%) symptoms were high and the severity was at moderate levels. The prevalence of pruritus (40.2%), rash (34.2%), dry skin (41.9%), and diarrhea (17.1%) symptoms were low and the severity was at mild levels. 65.8% of patients reported uncertainty, with mild to moderate levels. Furthermore, 97.4% of the patients made some effort in SDM, and the effort level was moderate (mean: 5.56 ± 2.02). 64.1% of patients were certain that immunotherapy was the best option. Age, uncertainty, and effort in the SDM process were major factors related to decisional conflict. We observed that older patients (age: ≥ 65) and those with higher uncertainty levels and less effort in SDM reported higher levels of decisional conflict. Future studies should explore older patients’ decisional related needs of immunotherapy. Interventions should be designed to reduce the uncertainty experienced by patients with cancer and enhance their understanding of immunotherapy to enable them to take more effort in the SDM process.

Adherence to anti-retroviral therapy, decisional conflicts, and health-related quality of life among treatment-naïve individuals living with HIV: a DEARS-J observational study

BackgroundSupporting people living with HIV using anti-retroviral therapy (ART) is important due to the requirement for strict medication adherence. To date, no data from longitudinal studies evaluating adherence by treatment-naïve people living with HIV are currently available. We investigated the adherence of treatment-naïve people living with HIV over time and examined the relationships among decisional conflicts, adherence, and health-related quality of life (HRQL).MethodsThe survey items included adherence (visual analogue scale [VAS]), decisional conflict (decisional conflict scale [DCS]), and HRQL (Medical Outcomes Study HIV Health Survey [MOS-HIV]). The DCS and MOS-HIV scores and the VAS and MOS scores were collected electronically at the ART initiation time point and at 4-, 24-, and 48-week post-treatment time points.ResultsA total of 215 participants were enrolled. The mean DCS score was 27.3 (SD, 0.9); 23.3% of participants were in the high-score and 36.7% in the low-score groups. The mean adherence rates at 4, 24, and 48 weeks were 99.2% (standard error [SE], 0.2), 98.4% (SE, 0.4), and 96.0% (SE, 1.2), respectively. The least-square means of the MOS-HIV for the DCS (high vs. low scores) were 64.4 vs. 69.2 for general health perceptions and 57.7 vs. 64.0 for HRQL, respectively.ConclusionAdherence among treatment-naïve people living with HIV was maintained at a higher level, and HRQL tended to improve with ART. People with high levels of decisional conflict tended to have lower HRQL scores. Support for people living with HIV during ART initiation may be related to HRQL.

Shared decision-making for pediatric elective penile surgery.

In pediatric surgery, proxy decision-makers are frequently involved in treatment planning and may experience decisional conflict (DC). Shared decision-making (SDM) approaches may be effective to remedy DC. This study investigates DC and SDM involvement in elective pediatric penile surgery. Forty-four parents of children aged <8 years undergoing elective penile surgery consultations at a tertiary pediatric hospital were prospectively enrolled. Patient and physician questionnaires were used to assess the SDM process and the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) screening test was used to assess DC. Thirty-seven (84.1%) mothers and seven (15.9%) fathers were enrolled for circumcision (n=33, 75.0%) and distal hypospadias repair (n=11, 25.0%) consultations, with 21 (47.7%) choosing to proceed with surgery. Seven (15.9%) participants experienced clinically significant DC. Participant gender was not associated with higher levels of DC (p=0.318). The average patient and physician SDM scores were 88.2±10.0 and 85.3±7.4, respectively, with no correlation found between participant and physician perception of SDM involvement (p=0.168, p=0.276). DC was significantly associated with lower participant and physician ratings of SDM. There was a high perception of SDM involvement by both parents and pediatric urologists regarding elective penile surgery. Of the 15% of parents experiencing DC, there was an association with lower participant and physician levels of SDM involvement. Despite high SDM scores overall, discrepancies exist between the perceived physician and participant SDM involvement.

MP43-02 PREFERENCE ELICITATION AND TREATMENT DECISION MAKING AMONG MEN DIAGNOSED WITH LOCALIZED PROSTATE CANCER: RESULTS FROM THE HEALIUM TRIAL

You have accessJournal of UrologyCME1 May 2022MP43-02 PREFERENCE ELICITATION AND TREATMENT DECISION MAKING AMONG MEN DIAGNOSED WITH LOCALIZED PROSTATE CANCER: RESULTS FROM THE HEALIUM TRIAL Michael Diefenbach, Simon Hall, Manish Vira, Michael Schwartz, Erin Tagai, Alexander Kutikov, Andres Correa, Halie Pfister, Andrea Yacoub, and Suzanne Miller Michael DiefenbachMichael Diefenbach More articles by this author , Simon HallSimon Hall More articles by this author , Manish ViraManish Vira More articles by this author , Michael SchwartzMichael Schwartz More articles by this author , Erin TagaiErin Tagai More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Andres CorreaAndres Correa More articles by this author , Halie PfisterHalie Pfister More articles by this author , Andrea YacoubAndrea Yacoub More articles by this author , and Suzanne MillerSuzanne Miller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment decision-making for localized prostate cancer is complex and is influenced by on patients’ personal preferences. Although important, personal preferences are rarely comprehensively assessed in the clinical encounter and incorporated in the treatment selection process. Ignoring of patient preferences has been associated with higher levels of decisional conflict and decisional regret. Objective: To evaluate Healium, a brief interactive tool to aide men diagnosed with localized prostate cancer in preference identification and medical decision-making, in a randomized controlled trial. METHODS: Men diagnosed with localized prostate cancer (N=281) recruited from two hospitals were randomized to receive Healium or, matched for time and attention, the Healing Choices for men with prostate cancer, an established online education tool. Healium can be completed in 10 minutes or less and focuses on treatment preferences. Healing choices’ content, can takes several hours to explore. The programs were introduced prior to a consultation with the physician. Decisional conflict, the primary outcome variable, was assessed at baseline, at 6 weeks and 3 months. RESULTS: Men were on average 64 years old (SD=6.93), 25% minority; 78% married; and had a bachelor’s degree or below (73.4%). At baseline mean decisional conflict was 36.06 (SD=28) for Healium and 32.96 (SD=24.52) for Healing Choices, indicating moderate decisional conflict (range 0-100; 100 extreme conflict). At six weeks post consultation decisional conflict decreased significantly in both conditions: 7.13 (SD=15.26) for Healium; 6.61 (SD=13.04) for Healing Choices; (F(1,213) = 0.068; ns). We found no differences in decisional conflict subscales by intervention type or any moderating effect of age, education, or race. CONCLUSIONS: Software education programs such as Healium or Healing Choices significantly decrease treatment decisional conflict among men diagnosed with prostate cancer. The short time it takes to complete Healium and its effectiveness, however, makes it an ideal tool for use in clinical practice. Integration into the electronic medical health records and a guide for clinicians to discuss patient preferences are next steps in the implementation of the program. Source of Funding: American Cancer Society, Research Scholar Award (RSG-15-021-01-CPPB) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e740 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Diefenbach More articles by this author Simon Hall More articles by this author Manish Vira More articles by this author Michael Schwartz More articles by this author Erin Tagai More articles by this author Alexander Kutikov More articles by this author Andres Correa More articles by this author Halie Pfister More articles by this author Andrea Yacoub More articles by this author Suzanne Miller More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD48-11 DECISIONAL CONFLICT IN PARENTS REGARDING NEWBORN CIRCUMCISION

You have accessJournal of UrologyCME1 May 2022PD48-11 DECISIONAL CONFLICT IN PARENTS REGARDING NEWBORN CIRCUMCISION Hannah Botkin, Denise Juhr, Douglas Storm, Christopher Cooper, and Gina Lockwood Hannah BotkinHannah Botkin More articles by this author , Denise JuhrDenise Juhr More articles by this author , Douglas StormDouglas Storm More articles by this author , Christopher CooperChristopher Cooper More articles by this author , and Gina LockwoodGina Lockwood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Informed consent is obtained prior to circumcision of newborn males, but little is known about the degree of uncertainty parents experience surrounding the choice of whether or not to circumcise. We evaluated the degree of decisional conflict (DC) in parents of male children and children of unknown sex during the prenatal period. METHODS: We administered a validated questionnaire, the Decisional Conflict Scale (DCS), to pregnant mothers carrying a male child or child of unknown sex during prenatal care visits as well as to expecting parents via an institution-wide survey. DCS total score was calculated on a scale of 0 to 100, with 0 representing no DC, and 100 representing extremely high DC. Total score, as well as uncertainty, informed, values clarity, support, and effective decision subscores were calculated. Decisional conflict was considered to be low with a score of less than 25, intermediate with scores between 25 and 37.5 and high with scores greater than 37.5. Unpaired t-test was used to compare results between groups. RESULTS: 153 DCS were completed and analyzed. All mothers approached for survey completion during prenatal visits completed the survey. 57.9% (n=88) of respondents reported they would choose circumcision for their male child, with 33% (n=51) choosing not to circumcise, and the remaining 8.6% (n=13) unsure about the choice. Mean total DCS score was higher (mean = 44.4, SD 11.9) for parents reporting they were unsure, than those who selected circumcision (mean = 12.9, SD 14.2; p <0.0001) or no circumcision (mean = 5.5, SD 8.7; p <0.0001). Mean scores were not significantly different from trimester to trimester, and the number of those unsure about the decision were spread evenly between the first, second and third trimesters. Subscale scores were all low for conflict in those who had decided on circumcision or against it. All subscale scores in the unsure group were high, with the highest being the uncertainty subscale (mean = 62.8, SD 15.8) and the values clarity subscale (mean = 48.1, SD 14.9). CONCLUSIONS: Our survey data showed that a small proportion of parents-to-be do experience high levels of DC regarding the decision of whether or not to circumcise. Importantly, some parents report not understanding the risks, benefits, and side effects of this procedure, as reflected in the informed subscore or understanding the relative importance of their own values in this decision, as reflected in the values clarity subscore. Better understanding of the modifiable factors contributing to this hesitancy could help providers alleviate conflict and regret regarding this decision. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e803 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Botkin More articles by this author Denise Juhr More articles by this author Douglas Storm More articles by this author Christopher Cooper More articles by this author Gina Lockwood More articles by this author Expand All Advertisement PDF DownloadLoading ...

Oral literacy in pediatric otolaryngology surgical consultations amongst parents with high levels of decisional conflict

ObjectivesOral literacy is an important aspect of physician and patient/family communication. Adequate communication is essential in the shared decision-making process and is inherently important in pediatric surgical consultations where parents must make decisions for their children. The aim of this study was to describe oral literacy in pediatric otolaryngology consultations and how it may relate to shared decision-making in a cohort of parents experiencing significant decisional conflict. MethodsThirty-six parent/patient-physician interactions from two pediatric otolaryngology clinics were recorded. Parents completed the Decision Conflict Scale (DCS), and both parents and physicians completed the Shared Decision-making (SDM-Q-9/SDM-Q-Doc) questionnaires. Language complexity was assessed by the Flesch Reading Ease Scale (FRES), the Simple Measure of Gobbledygook (SMOG) Readability Formula, and a series of grammar statistics. The Pearson product-moment was used to examine the correlation between measures. ResultsThe mean age of parents was 32.3 (mother) and 34.8 (father) years, with the majority having a college education or greater (77.8%). The mean DCS score was 85.8 (range 56–100), and all parents reported clinically significant conflict scores (DCS score > 25). Physicians spoke at a higher-grade level (mean difference SMOG 1.2 (95% CI: 0.8–1.6)), with more words per sentence (mean difference 3.7 (95% CI: 2.4–4.9)), and longer words (mean difference 0.1 (95% CI: 0.03–0.16)). Parents who had higher language complexity experienced less decisional conflict (SMOG vs DCS, r = −0.471, p = 0.004; words per sentence, r = −0.414, p = 0.012; word length, r = −0.419, p = 0.011), but there was no correlation between physician language complexity and DCS or SDM-Q-9 scores. ConclusionPhysicians demonstrated higher language complexity than that of parents in this study. Differences in language complexity between physicians and parents do not appear to play a substantial role in decisional conflict or the perception of shared decision-making in general. However, parents who use a more complex vocabulary may experience less conflict.

Decisional conflict among people with diabetes mellitus or hypertension attending primary care

Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale "information" had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.

Cancer-related distress in unselected women with newly diagnosed breast or ovarian cancer undergoing BRCA1/2 testing without pretest genetic counseling

Background: Genetic testing is increasing in patients newly diagnosed with cancer. This study investigated the levels, course and predictors of cancer-related distress, defined as intrusion and avoidance, in women undergoing BRCA1/2 testing without pretest genetic counseling shortly after a diagnosis of breast or ovarian cancer.Material and methods: Unselected for family history or age, 259 women with breast cancer and 50 women with ovarian cancer, underwent BRCA1/2 testing shortly after diagnosis. Cancer-related distress was measured with the Impact of Event Scale before and after genetic testing. In order to identify predictors of distress, the subscale scores were regressed on baseline predictor variables including sociodemographic and medical variables, perceived social support, and decisional conflict regarding genetic testing.Results: The mean levels of intrusion and avoidance were in the moderate range both before and after genetic testing with a statistically significant decline during follow-up. Younger age, shorter time since diagnosis, lower levels of social support, and a diagnosis of ovarian cancer predicted higher levels of both intrusion and avoidance. In addition, higher levels of decisional conflict and living with a partner predicted higher levels of intrusion.Conclusions: Women having genetic testing shortly after a diagnosis of breast or ovarian cancer had a moderate mean level of cancer-related distress, which decreased with time. Health personnel offering genetic testing to newly diagnosed women with breast or ovarian cancer should be aware of the potential predictors for increased cancer-related distress identified in this study: younger age, less perceived social support, higher levels of decisional conflict regarding genetic testing, and living with a partner.

Reciprocity within patient-physician and patient-spouse/caregiver dyads: insights into patient-centered care.

To explore the reciprocal process of decisional conflict within the patient-physician dyad, and its relationship with patient general health and patient-perceived physician helpfulness. Among the subset of participants who were in a committed relationship, we examined the congruence in reciprocal processes between patient-spouse/caregiver and patient-physician dyads. An online retrospective survey of cancer patients was conducted in the USA. The reciprocal process of decisional conflict within the patient-physician dyad was measured using the Decisional Conflict Scale (DCS). The Perception of Spousal Reciprocity Scale (POSRS) was used to measure reciprocity in the patient-spouse/caregiver dyad. The final analytic cohort consisted of 116 participants. The average age of participants was 58.4years, the majority were female (66.7%), and the most common diagnosis was breast cancer (27.9%). Participants who perceived their physician as more helpful were more likely to report lower levels of decisional conflict on the DCS total scale and subscales (r range = 0.24-0.46, p < 0.05). Higher scores on the PSORS were associated with lower levels of decisional conflict (r = - 0.37, p < 0.01). Participants not in a relationship had higher levels of decisional conflict about their treatment decisions (M = 21.69) than participants in a relationship (M = 9.69, t(26.95) = - 2.26, p = 0.032). Physicians are an important resource for both the patient and caregiver during the cancer journey. Understanding reciprocal processes within the patient-physician relationship related to patient-centered care and including the caregiver in the medical decision-making process can decrease the threat of decisional conflict and subsequent adverse outcomes.

Decisional conflict in end-of-life cancer treatment among family surrogates: A cross-sectional survey.

The aims of this study were to examine the extent of decisional conflict in end-of-life cancer treatments and to investigate the influences and predictors of decisional conflict among family surrogates. A cross-sectional, descriptive, correlational design was applied. Data were collected from a convenience sample of 102 family members who had participated in end-of-life cancer decision-making. We enrolled participants from inpatient oncology units at a university hospital in South Korea from May 2014 to January 2016. The results indicated that many family surrogates had high levels of decisional conflict and psychological stress after end-of-life cancer decision-making. Hierarchical multiple regression analyses demonstrated that decisional conflict had significant, substantial influences on decision regret and psychological stress after controlling for demographic variables. Family surrogates who were aware of the patients' wishes about end-of-life treatments and those who had good family functioning had less decisional conflict. To relieve decisional conflict regarding end-of-life cancer treatment among family surrogates, it is necessary to encourage patients to share their end-of-life treatment wishes with family members and to consider family functioning in the end-of-life decision-making process.

Decisional conflict in mental health care: a cross-sectional study.

Decisional conflict refers to the degree to which patients are engaged in and feel comfortable about important clinical decisions. Until now, the concept has received little attention in mental health care. We investigate the level of decisional conflict in mental health care and whether this is influenced by socio-demographics, treatment setting, diagnoses, and locus of control. Cross-sectional study among 186 patients in Dutch specialist mental health care using the Decisional Conflict Scale, which measures five dimensions of decisional conflict: information, support, clarification of values, certainty, and decisional quality. Descriptive statistics and forward stepwise linear regression analyses were used. Patients report relatively high levels of decisional conflict, especially those with more external locus of control. Having a personality disorder and higher education also increases decisional conflict on the dimensions support and clarification of values, respectively. Less decisional conflict was experienced by patients with psychotic disorders on the dimension certainty and by women on the information domain. Decisional conflict is common among patients in specialist mental health care and is very useful for assessing the quality of clinical decision making. Measuring decisional conflict and knowledge about influencing factors can be used to improve patients' participation in clinical decision making, adherence to treatment and clinical outcomes.

A feasibility randomised controlled trial of the DECIDE intervention: dementia carers making informed decisions.

SummaryFamily carers report high levels of decisional conflict when deciding whether their relative with dementia can continue to be cared for in their own home. We tested, in a feasibility randomised controlled trial, the first decision aid (the DECIDE manual) aiming to reduce such conflict. Twenty family carers received the DECIDE intervention, and 21 received usual treatment. The intervention group had reduced decisional conflict compared with controls (mean difference −11.96, 95% confidence interval −20.10 to −3.83, P=0.005). All carers receiving the intervention completed and valued it, despite some still reporting difficulties with family conflict and problems negotiating services.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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.

Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation.

Many young adult female cancer survivors (YAFCS) are at risk of experiencing premature menopause. The current study characterized the posttreatment fertility information needs, reproductive concerns, and decisional conflict regarding future options for posttreatment fertility preservation (FP) among YAFCS. Participants completed a Web-based, anonymous survey between February and March 2015. The survey included investigator-designed questions of perceived information needs, the Reproductive Concerns After Cancer Scale, and the Decisional Conflict Scale. Analyses included Pearson correlation coefficients, independent-sample Student t tests, and multiple regression. There was a total of 346 participants with an average age of 29.9 years (SD = 4.1 years) who were 4.9 years from treatment (SD = 5.4 years [range, 0-27 years]). The main analyses focused on a subgroup of YAFCS with uncertain fertility status who had not previously undergone/attempted FP and either wanted future children or were unsure (179 women). Across fertility information topics, 43% to 62% of participants reported unmet information needs. The greatest reproductive concerns were related to fertility potential and the health of future offspring. The regression model controlled for a priori covariates including current age, age at treatment completion, income, relationship status, nulliparity, and prior fertility evaluation. Greater unmet information needs were found to be related to greater decisional conflict (β = .43; p<.001); greater reproductive concerns were associated at the trend level (β = .14, p = .08; F[8,118] = 6.42, p<.001). YAFCS with limited awareness or knowledge of their risk of experiencing premature menopause and FP options reported higher levels of decisional conflict regarding future FP. Posttreatment survivorship care should include comprehensive reproductive health counseling, including posttreatment FP options and family-building alternatives. Cancer 2016;122:2101-9. © 2016 American Cancer Society.

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

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

Decision making for depression treatment during pregnancy and the postpartum period

To explore women's perspectives about the treatment decision-making process for depression during pregnancy and after birth. One hundred pregnant and postpartum women completed an anonymous web-based surveys regarding treatment decision making for depression. Survey data reveal that most women in this sample prefer an active collaborative role in treatment decision making for depression. Sixty-five percent of the sample made a decision for treatment of their major depressive disorder, including a decision for no treatment, and 34% reported not having made a decision or feeling unsure about their decision. More than half of the sample preferred combination treatment with medications and counseling (55%) followed by counseling (22%), no treatment (8%), and medications (8%). Overall, respondents in this sample had low levels of decisional conflict (uncertainty) with younger women in the sample reporting higher levels of decisional conflict. Treatment decision making for depression during the perinatal period is complex. Asking women about their preferences for participation in decision making, their treatment preferences and their decision making needs during the clinical encounter may lead to improved communication, decision making and quality of care.

An evaluation of two decision-making scales for children with life-limiting illnesses

Purpose Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. Methods Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. Results Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. Conclusion Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.

Will men attribute fault to their GP for adverse effects arising from controversial screening tests? An Australian study using scenarios about PSA screening

To determine men's attribution of fault for adverse consequences of prostate-specific antigen (PSA) screening. Representative, population-based sample recruited from Sydney, Australia (n=405). Telephone interview to assess reactions to two scenarios: Scenario 1, depicting a GP who dismisses an opportunity to order a PSA test (missed diagnosis); and Scenario 2, depicting a GP who recommends PSA screening to a patient who then experiences adverse outcomes from treatment of his prostate cancer (iatrogenic consequences). Two-thirds of participants (66.9%) ascribed fault to the GP in Scenario 1. Men in fair or poor health (adjusted odds ratio [AOR] 1.81; 95% confidence interval [CI] 1.04-3.12; p=0.03) and those with better knowledge about PSA screening (AOR 0.98; 95% CI 0.97-0.99; p=0.002) were significantly and independently more likely to ascribe fault in Scenario 1. By contrast, only 15.8% of participants ascribed responsibility to the GP in Scenario 2. Older men (AOR 1.05; 95% CI 1.00-1.10; p=0.04) and those with higher levels of decisional conflict (AOR 1.19; 95% CI 1.04-1.37; p=0.01) were significantly and independently more likely to ascribe responsibility. Public education could better target men's tendency to ascribe fault to GPs when they miss an opportunity to diagnose prostate cancer early through PSA screening, even though the corollary of potential iatrogenic consequences is perceived as less blameworthy. As decisional conflict and knowledge were found to predict attribution of fault, evidence-based information may reduce the medicolegal volatility of this controversy.