Levels Of Decisional Conflict Research Articles

Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults.

Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's = .31-.37, p < .001), and ACP engagement (r's = -.41 to -.37, p < .001) indicated convergent validity. A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.

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. 4 Laryngoscope, 134:3604-3610, 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.

Experiences of decisional conflict related to epidural labour analgesia among women during late pregnancy in a tertiary hospital in China: a mixed methods study

BackgroundResearch has indicated some women were in a state of uncertainty about pharmacological pain management decisions, which may lead to maternal anxiety and decisional regret. However, little is known about decisional conflict in the choice of epidural labour analgesia amongst Chinese women. AimThis study aimed to investigate the level of and reasons underlying decisional conflict in Chinese women during their late pregnancy when making a decision on the use of epidural analgesia in labour. MethodsA convergent parallel mixed methods study was undertaken, that included a quantitative survey (n = 323) and qualitative interviews (n = 17) with women recruited from a tertiary general hospital in Hangzhou, China. The quantitative survey assessed the level of and its influencing factors of women's decisional conflict, while the qualitative interview further explored experiences of and reasons underlying the conflict. FindingsParticipants reported a high level of decisional conflict (mean±SD, 39.59±15.92), which related to decision delay and/or negative perceptions about the decision. Multiple stepwise linear regression analysis identified that highest level of education and knowledge of epidural were negatively associated with decisional conflict (p<0.05). Four decision-making styles (rational, dependant, intuitive and avoidant decision-making) associated with different levels of decisional conflict, and four underlying reasons (personal characteristics, informational provision, emotional support and participation in decision-making) of the conflict were thematized. ConclusionDecisional conflict related to epidural labour analgesia is a noteworthy issue amongst women during their late pregnancy. This study suggests a need for provision of family-centred shared decision-making practice about the use of epidural analgesia in labour.

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.

Decisional Support Needed when Facing Tough Decisions: Survey of Parents with Children having Differences of Sex Development.

Parents of infants and young children newly diagnosed with differences of sex development (DSD) commonly face medical and psychosocial management decisions at a time when they are first learning about the condition and cannot consult their child for input. The aim of this study was to identify areas of greatest need for parental decisional support. 34 parents of children receiving care for DSD at one of three US children's hospitals participated in a survey to learn what clinical and psychosocial decisions needed to be made on behalf of their child. Parents were then asked to identify and focus on a "tough" decision and respond to questions assessing factors affecting decision-making, decision-making preferences, decisional conflict, and decision regret. Descriptive analyses were conducted. Decisions about surgery and aspects of sharing information about their child's condition with others were the two most frequently reported decisions overall, experienced by 97% and 88% of parents, as well as most frequently nominated as tough decisions. Many parents reported mild to moderate levels of decisional conflict (59%) and decision regret (74%). Almost all parents (94%) reported experiencing at least one factor as interfering with decision-making (e.g., "worried too much about choosing the 'wrong' option"). Parents universally reported a desire to be involved in decision-making - preferably making the final decision primarily on their own (79%), or together with their child's healthcare providers (21%). The majority of parents judged healthcare providers (82%) and patient/family organizations (58%) as trustworthy sources of information. Parents of children with DSD encounter medical, surgical, and psychosocial management decisions. Despite difficulties including emotional distress and informational concerns (including gaps and overload), parents express strong desires to play key roles in decision-making on behalf of their children. Healthcare providers can help identify family-specific needs through observation and inquiry in the clinical context. Together with families, providers should focus on specific clinical management decisions and support parental involvement in making decisions on behalf of young children with DSD.

P-452 Suboptimal quality of integrated female oncofertility care is associated with a lowered quality of life and more decisional conflict and regret in female cancer survivors

Abstract Study question Is quality of female oncofertility care associated with quality of life, decisional conflict, regret, reproductive concerns, and fertility preservation knowledge in female cancer survivors? Summary answer Receiving high-quality integrated female oncofertility care is associated with an improved quality of life, and with less decisional conflict and regret in female cancer survivors. What is known already Female adolescent and young adult cancer patients should be informed about their infertility risks due to cancer treatment. However, adherence to oncofertility guidelines is far from optimal. At this moment, it is not known whether adherence to oncofertility guidelines measured with quality indicators is associated with a better quality of life, less decisional conflict, regret, and reproductive concerns in female cancer survivors Study design, size, duration A multicenter cross-sectional survey study was conducted to measure the association between quality of oncofertility care and patient-reported outcome measures (PROMs). Participants/materials, setting, methods Female AYA cancer survivors (18-40 years) who were diagnosed in 2016 or 2017, and received a (potential) gonadotoxic treatment were eligible to participate. They were recruited from six hospitals across the Netherlands and were asked to fill in a survey. Quality indicators were used to assess quality of care, and validated scales to assess PROMs. Quality indicator and PROM scores were calculated, and associations were analyzed by T-tests and multilevel multivariate analyses Main results and the role of chance In total, 121 out of 344 female cancer survivors participated. Female cancer survivors received a suboptimal quality of care with 8 out of 11 quality indicators scoring &amp;lt;90% adherence. Of all patients, 72,7% was informed about their infertility, 51,2% was offered a referral, with 18,8% all aspects were discussed in counselling, and 35,5% received written and/or digital information. When survivors were informed about infertility risks, and were offered fertility preservation counseling, and received digital/written information (i.e. adherence to three quality indicators), their quality of life was highest, and levels of decisional conflict and regret were lowest. Physical quality of life, decision regret, reproductive concerns, and fertility preservation knowledge scores were significantly influenced by female cancer survivor’s age, relationship status, strength of wish to conceive, and type of cancer. Limitations, reasons for caution Selection bias could have occurred as we have no insight into reasons for non-responding and we have a low response rate. Furthermore, recall bias could have played a role as patients were asked to fill in questions three to four years after their diagnosis, treatment, and consultation. Wider implications of the findings As quality of oncofertility care is suboptimal, strategies should be developed and tailored to the current gaps, and to guideline-specific barriers, to improve quality of care and, importantly, quality of life in female cancer survivors. Trial registration number N/A

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 ...

Decisional Conflict is Associated with Treatment Modality and not Disease Knowledge in South African Men with Prostate Cancer: Baseline Results from a Longitudinal Prospective Observational Study.

BackgroundDecisional conflict (DC) is a psychological construct that an individual experiences in making a decision that involves risk, loss, regret, or challenges to one’s values. This study assessed DC in a cohort of South African men undergoing curative treatment for localised prostate cancer (LPC). The objectives were to (1) to examine the association between DC and prostate cancer knowledge (PCK), demographics, state anxiety, prostate cancer anxiety and time to treatment and (2) to compare levels of DC between treatment groups [prostatectomy (RP) and external beam radiation (RT)].MethodData, comprising the Decisional Conflict Scale (DCS), Prostate Cancer Knowledge (PCK), State-Trait Anxiety Inventory (STAI-S), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and demographic data from 83 participants of a larger prospective longitudinal observational study examining depression, anxiety and health related quality of life (DAHCaP) were analysed.ResultsThe mean age of participants was 63 years (RP 61yrs and RT 65yrs; p< 0.001). Most were of mixed ancestry (72.3%). The total DCS scores between the treatment groups (RP 25.00 and RT 18.75; p = 0.037) and two DCS sub-scores-uncertainty (p = 0.033), and support (p = 0.048), were significantly higher in the RP group. A statistically significant negative correlation was observed between state anxiety and time between diagnosis and treatment in the RP group (Spearman’s rho = −0.368; p = 0.030). There was no correlation between the DCS score and PCK within each treatment group (Spearman’s rho RP = −0.249 and RT = −0.001).ConclusionDecisional conflict was higher in men undergoing RP. Men were more anxious in the RP group regarding the time treatment was received from diagnosis. No correlation was observed between DC and PCK. Pre-surgical management of DC should include shared decision making (SDM) which is cognisant of patients’ values facilitated by a customised decision aid.

Effect of Shared Decision-making on Decisional Conflict and Uptake of First-trimester Screening Tests

Introduction: Several factors influence women’s decision to take First Trimester Screening (FTS) tests. These factors are associated with the ambivalence of women toward undergoing screening tests. Objective: This study aimed to investigate the effect of Shared Decision-Making (SDM) about undergoing FTS on Decisional Conflict (DC) immediately after consultation and uptake of FTS. Materials and Methods: This quasi-experimental study was conducted on 200 pregnant women (100 women in the intervention and 100 in the control groups) referred to health centers for prenatal care in 2019. They were selected by the block randomization sampling method. The control group received the routine care and the intervention group, in addition to routine care, attended a 90-min long consultation session based on SDM. The women were contacted via phone at 14 weeks of pregnancy to collect data on their undertaking prenatal screening tests. The demographic characteristics form and O’Conner’s decisional conflict scale were filled out immediately after the consultation session for the intervention group. The obtained data were analyzed by the Chi-square, Fisher exact-test, Mann-Whitney U, and linear regression tests. The P value less than 0.05 was considered statistically significant. Results: There was no significant difference between the two groups regarding women’s demographic characteristics, except for education level, job, and insurance coverage. The Mean±SD DC score was significantly lower in the intervention group (7.35±8.55) compared to the control group (27.32±13.81) (95%CI; 16.80-24.19, P=0.001). In addition, there was a significant difference between the two groups in terms of undergoing the offered FTS (P=0.04). The DC scores ≥25 were associated with a decreased chance of undergoing FTS (P=0.02). Women were less likely to undergo FTS when they were self-employed (OR=0.15, 95%CI; 0.03-0.71, P=0.01). Conclusion: The SDM consultation can help women experience significantly lower levels of DC. Furthermore, factors such as self-employment can prevent women from undergoing FTS despite lower levels of DC.

Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants.

In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population. Observational cross-sectional study. Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5). Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant. Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.

Abstract 10796: Patient and Clinician Perspectives of Decision Quality Surrounding Atrial Fibrillation Ablation: A Mixed-Methods Study

Introduction: Catheter ablation is a common treatment for atrial fibrillation (AF) with nuanced risks and benefits. Shared decision-making (SDM) could guide the decision to undergo ablation based on patient values and goals of care. Understanding whether and how SDM about ablation is conducted in clinical practice would allow us to determine how to optimize patient decision making and decision quality. The objective of this study was to investigate decision quality and SDM practices surrounding AF ablation. Methods: We conducted a mixed-methods study guided by Sepucha &amp; Scholl’s (2014) SDM framework which specifies decision antecedents, processes, and outcomes. We recruited a convenience sample of AF ablation patients (n=15) and clinicians (n=5; 3 MDs, 1 PA, 1 NP) from a hospital in Queens, New York. Patients completed the AF Symptom Survey (AFSS), Controls-Preferences scale (CPS), and Decisional Conflict scale (DCS), which were summarized using descriptive statistics (median, interquartile range [IQR], and frequency). Patients and clinicians completed semi-structured interviews, which were analyzed using directed content analysis. Participants received $25 as compensation. The Weill Cornell Medicine IRB approved this study. Results: Patients’ median age was 71.0 years (IQR 69.0-78.5), 27% were female, 67% were White, and 73% spoke English. The median AFSS score was 0 (IQR 0-1.0) out of 35 indicating low symptom burden post-ablation. The median DCS score was 7.0 (IQR 0-16.4) out of 100 indicating low levels of conflict. On the CPS 4 patients (27%) preferred to have some control in decision-making; the remainder preferred to share control or relinquish it to clinicians. Qualitative findings underscore low levels of decisional conflict but limited patient agency (Table) . Conclusion: Findings suggest opportunities to improve decision quality surrounding AF ablation by bolstering patient agency, possibly through educational materials and decision aids.

Decision-making in imminent extreme premature births: perceived shared decision-making, parental decisional conflict and decision regret.

To describe levels of perceived shared decision making (SDM), decisional conflict (DC), and decision regret (DR) in prenatal counseling by pregnant women, partners, neonatologists, and obstetricians regarding decision-making around imminent extreme premature birth in which a decision about palliative comfort care versus early intensive care had to be made. Multicenter, cross-sectional study using surveys to determine perceived SDM at imminent extreme premature birth in parents and physicians, and to determine DC and DR in parents. In total, 73 participants from 22 prenatal counseling sessions were included (21 pregnant women, 20 partners, 14 obstetricians, 18 neonatologists). High perceived levels of SDM were found (median 82,2), and low levels of DC (median 23,4) and DR at one month (median 12, 5). Reported levels of self-perceived SDM in the setting of prenatal counseling in extreme prematurity were high, by both the parents and the physicians. Levels of DC and DR were low.

Can patient decision aids reduce decisional conflict in a de-escalation of breast radiotherapy clinical trial? The PRIMETIME Study Within a Trial implemented using a cluster stepped-wedge trial design

BackgroundFor patients with early breast cancer considered at very-low risk of local relapse, risks of radiotherapy may outweigh the benefits. Decisions regarding treatment omission can lead to patient uncertainty (decisional conflict), which may be lessened with patient decision aids (PDA). PRIMETIME (ISRCTN 41579286) is a UK-led biomarker-directed study evaluating omission of adjuvant radiotherapy in breast cancer; an embedded Study Within A Trial (SWAT) investigated whether PDA reduces decisional conflict using a cluster stepped-wedge trial design.MethodsPDA diagrams and a video explaining risks and benefits of radiotherapy were developed in close collaboration between patient advocates and PRIMETIME trialists. The SWAT used a cluster stepped-wedge trial design, where each cluster represented the radiotherapy centre and referring peripheral centres. All clusters began in the standard information group (patient information and diagrams) and were randomised to cross-over to the enhanced information group (standard information plus video) at 2, 4 or 6 months. Primary endpoint was the decisional conflict scale (0–100, higher scores indicating greater conflict) which was assessed on an individual participant level. Multilevel mixed effects models used a random effect for cluster and a fixed effect for each step to adjust for calendar time and clustering. Robust standard errors were also adjusted for the clustering effect.ResultsFive hundred twenty-one evaluable questionnaires were returned from 809 eligible patients (64%) in 24 clusters between April 2018 and October 2019. Mean decisional conflict scores in the standard group (N = 184) were 10.88 (SD 11.82) and 8.99 (SD 11.82) in the enhanced group (N = 337), with no statistically significant difference [mean difference − 1.78, 95%CI − 3.82–0.25, p = 0.09]. Compliance with patient information and diagrams was high in both groups although in the enhanced group only 121/337 (36%) reported watching the video.ConclusionThe low levels of decisional conflict in PRIMETIME are reassuring and may reflect the high-quality information provision, such that not everyone required the video. This reinforces the importance of working with patients as partners in clinical trials especially in the development of patient-centred information and decision aids.

Increasing access to individualized medicine: a matched-cohort study examining Latino participant experiences of genomic screening

PurposeMultiple efforts are underway to increase the inclusion of racial minority participants in genomic research and new forms of individualized medicine. These efforts should include studies that characterize how individuals from minority communities experience genomic medicine in diverse health-care settings and how they integrate genetic knowledge into their understandings of health-care needs. MethodsAs part of a large, multisite genomic sequencing study, we surveyed individuals to assess their decision to pursue genomic risk evaluation. Participants included Latino patients recruited at Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, and non-Latino patients recruited at a large academic medical center (Mayo Clinic in Rochester, MN). Both groups agreed to receive individualized genomic risk assessments. ResultsComparisons between cohorts showed that Latino respondents had lower levels of decisional conflict about pursuing genomic screening but generally scored lower on genetic knowledge. Latino respondents were also more likely to have concerns about the misuse of genomic information, despite both groups having similar views about the value of genomic risk evaluation. ConclusionOur results highlight the importance of evaluating sociocultural factors that influence minority patient engagement with genomic medicine in diverse health-care settings.

Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery.

To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC). Cross-sectional. Academic pediatric otolaryngology outpatient clinic. Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale-21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12). A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended. In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.

Shared decision making in implantable cardioverter-defibrillator patients

Abstract Background Implantable cardioverter-defibrillators (ICD) are effective in the prevention of sudden cardiac death and treating life-threatening arrhythmias. As the number of older patients increases, the number of implanted devices does as well. Evidence for current guidelines is mostly derived from trials conducted decades ago, in selected patient groups. Communicating the risks and benefits of an ICD to patients can be challenging. Shared decision making with the use of a decision aid has proven to result in more active patient participation and improved outcomes in several fields. Purpose The aim of our study is to evaluate the effect of an ICD specific decision aid in clinical practice. Methods We developed an evidence based decision aid according to the Delphi method. The decision aid was tested in 6 Dutch centres within a stepped wedge clustered randomized trial. We compared pre-procedural counselling with and without the use of a decision aid. Level of shared decision making was measured with the SDM-Q-9 in patients and SDM-Q-doc in caregivers. Additionally, we measured decisional conflict in patients with the decisional conflict scale questionnaire (DCS). This includes a subscore on how informed patients deemed to be. We included a set of 4 knowledge questions in our questionnaire. Differences between scoresbetween groups were analysed using the Mann-Whitney U test or One-way ANOVA. For categorical variables, we used the Chi-square test or Fishers Exact test accordingly. Results In total, we retrieved questionnaires from 234 caregivers and 150 patients. The majority of the patients were male (75%) and the mean age was 70±9 years. Levels of shared decision making were marked high in all groups. With the use of a decision aid, caregivers experienced significantly more shared decision making (median 78 (IQR 62–84) versus 81 (IQR 71–87) in the decision aid group (p=0.002)). Patients reported low levels of decisional conflict in both groups. There were also no differences for the subscales of the DCS (median 17 (IQR 6–25) in the control group vs 14 (IQR 5–23) in the decision aid group (p&amp;gt;0.05)). Patients reported to be very well informed (DCS subscale score of 0 in the control group vs 8 with a decision aid, p&amp;lt;0.05), although they answered the knowledge quiz poorly in both settings, with only 1 patient (0.067%) answering all the four question correctly (p&amp;lt;0.05). Conclusions Patients and caregivers report high levels of shared decision making. This is likely due to a bias associated with the study design, in which all participating centres were required to conduct elaborate pre-implantation counselling with patients as standard care, which is different from current clinical practice. Despite the implications of an ICD procedure, there was no decisional conflict and patients report to be well informed. This is in spite of low scores on the knowledge quiz. This illustrates the phenomenon of the unconsciously uninformed patient. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Federation of Medical Specialists (SKMS), Utrecht, The Netherlands