Satisfaction With Decision Research Articles

BMI is Not Associated with Chest-Specific Body Image, Complications or Revisions in Gender-Affirming Mastectomy: A Single-Center Cross-Sectional Study.

To analyze the impact of Body Mass Index (BMI) on clinical and patient-reported outcomes following gender-affirming mastectomy (GM). BMI is a barrier for obese patients seeking GM despite increasing evidence that it is safe in this population. Currently little is known about the impact of BMI on chest-specific body image and satisfaction following GM. This single-center, cross-sectional study included individuals 18 years and older who underwent GM between 1990-2020 and were at least 2 years post-operative. Patient-reported chest-specific body image was measured using the BODY-Q and Gender Congruence and Life Satisfaction (GCLS) chest subscales. Satisfaction was measured using the Holmes-Rovner Satisfaction with Decision (SWD) scale. Clinical and demographic variables were identified from chart review. Bivariate analysis was performed to determine if BMI was associated with chest-specific body image, satisfaction, complications within 30 days or revisions in GM. Two hundred twenty-seven individuals meeting eligibility criteria were contacted to participate and one hundred thirty-seven responded (60.4% response rate). The mean age was 29.1 (SD=9.0) and mean BMI was 30.9 (SD=8.0), with 26.4% (N=60) of the cohort having a BMI>35. Chest-specific body image, and satisfaction with decision did not vary by BMI or breast resection weight. Complications and revisions were not associated with BMI. Individuals undergoing GM reported high rates of satisfaction following GM regardless of BMI. Complication and revision rates did not vary significantly by BMI or breast resection weight. Surgeons should re-evaluate the role BMI plays in patient selection and counseling for GM.

MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023MP37-05 SATISFACTION WITH DECISION AND DECISIONAL REGRET AFTER MID-URETHRAL SLING AND URETHRAL BULKING INJECTION FOR STRESS URINARY INCONTINENCE Leia Kessler, Michael Schumeister, Dimindra Karki, Melissa Laudano, and Nitya Abraham Leia KesslerLeia Kessler More articles by this author , Michael SchumeisterMichael Schumeister More articles by this author , Dimindra KarkiDimindra Karki More articles by this author , Melissa LaudanoMelissa Laudano More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently limited data regarding patient-centered outcomes of satisfaction and decisional regret for treatment of stress urinary incontinence (SUI) in women. The objective of this study was to investigate long-term satisfaction and decisional regret amongst women who underwent mid-urethral sling surgery or urethral bulking injection for SUI. METHODS: This was a retrospective cohort study of patients who underwent a mid-urethral sling or urethral bulking procedure for SUI from 2015 to 2022 at our diverse, urban academic center. Demographic data were collected through chart review and surveys were conducted via telephone calls. Patient satisfaction and decisional regret were measured with the validated modified SDS-DRS scale (Satisfaction with Decision Scale- Decision Regret Scale). On the DRS, a score of 1 correlates with low decisional regret and a score of 5 correlates with high decisional regret. On the SDS, a score of 1 correlates with low satisfaction and a score of 5 correlates with high satisfaction. Descriptive statistics and Wilcoxan rank-sum tests were performed using STATA 15.0 with p<0.05 being significant. RESULTS: Of 97 women who underwent mid-urethral sling surgery called, 68 agreed to participate (70% response rate). The mean time since surgery was 46.7+/-23.11 months. The median score for the SDS was 4.0 (IQR 3.7, 4.8) and the median score on the DRS was 2.0 (IQR 1.2, 2.4). Nine (13%) women experienced surgical complications, which were not significantly associated with SDS (p=0.54) or DRS scores (p=0.54). In comparison, of 60 patients who underwent urethral bulking injection called, 31 agreed to participate (52% response rate). The mean time since surgery was 30.6+/-30.08 months. The median SDS score was 4.0 (IQR 3.5, 4.8) and median DRS score was 2.0 (IQR 1.4, 3.0). Three (10%) women experienced surgical complications, which were not significantly associated with SDS (p=0.17) or DRS scores (p=0.44). CONCLUSIONS: The results of this study show high satisfaction with decision and low decisional regret in women undergoing surgical treatment for SUI. The Satisfaction with Decision and Decisional Regret Scale allows a patient-centered analysis of surgical success that may aid in choosing a treatment option for women considering SUI surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e514 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leia Kessler More articles by this author Michael Schumeister More articles by this author Dimindra Karki More articles by this author Melissa Laudano More articles by this author Nitya Abraham More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of a Novel Clinical Decision-Making Tool in Vestibular Schwannoma Treatment.

To determine the usefulness of a personalized tool and its effect on the decision-making process for those with vestibular schwannoma (VS). Prospective study. Single institution, academic tertiary care lateral skull base surgery program. Patients diagnosed with VS. A comprehensive clinical decision support (CDS) tool was constructed from a previously published retrospective patient-reported data obtained from members of the Acoustic Neuroma Association from January to March 2017. Demographic, tumor, and treatment modality data, including associated side effects, were collected for 775 patients and integrated in an interactive and personalized web-based tool. Pre- and posttool questionnaires assessing the process of deciding treatment for VS using a decisional conflict scale (DCS) and satisfaction with decision (SWD) scale were compared. A pilot study of 33 patients evaluated at a single institution tertiary care center with mean ± SD age of 63.9 ± 13.5 years and with average tumor size of 7.11 ± 4.75 mm were surveyed. CDS implementation resulted in a mean ± SD total DCS score decrease from 43.6 ± 15.5 to 37.6 ± 16.4 ( p < 0.01) and total SWD score increase from 82.8 ± 16.1 to 86.2 ± 14.4 ( p = 0.04), indicating a significant decrease in decisional conflict and increase in satisfaction. Implementing a decision-making tool after diagnosis of VS reduced decisional conflict and improved satisfaction with decision. Patients considered the tool to be an aid to their medical knowledge, further improving their comfort and understanding of their treatment options. These findings provide a basis for developing predictive tools that will assist patients in making informed medical decisions in the future.

The effects of a video-based education in women with newly diagnosed breast cancer in Singapore

The purpose of this study was to evaluate the impact of an educational video among women who were newly diagnosed with breast cancer on knowledge, anxiety, and satisfaction with their surgical decision. A pre-post-test design was used to evaluate knowledge, anxiety, and satisfaction levels with decision-making regarding surgery among women with breast cancer. A purposive sampling strategy was implemented to compare outcomes of newly diagnosed breast cancer women who received standard of care that included breast care nurse counseling sessions and written materials to women who received standard of care plus a supplement educational video. Knowledge and anxiety scores were collected at baseline and 2weeks post-operatively. Satisfaction with decision (SWD) on the nature of surgery was gathered 2weeks after surgery. Sixty-two subjects were recruited in a Singapore tertiary cancer center with a cohort of 32 women in the non-video group and 30 women in the video group. There was a statistically significant interaction effect of group and time (p = .008), wherein knowledge increased for both groups, although the increase was steeper for the video group. Both groups had significantly lower anxiety at post-implementation compared to pre-implementation (p < .001). There were no differences in SWD scores in both groups. Use of an additional video-based education significantly increased breast cancer knowledge levels among women in the educational video group. Nurses and healthcare professionals should focus on identifying individual informational needs based on surgical options to provide personalize care and transfer the necessary knowledge in empowering woman's decision-making process on her nature of breast surgery.

Prospective assessment of patient-reported outcomes in gynecologic cancer patients before and after pelvic exenteration

ObjectivePelvic exenteration (PE) is a surgical procedure associated with significant morbidity offered to select women with locally advanced or recurrent gynecologic cancers. This ongoing study examines an array of patient-reported outcomes and satisfaction with PE. MethodsSince February 2009, prospectively enrolled participants completed questionnaires evaluating body image (BIS), depression (CESD), social support (DUFSS), symptoms (MDASI), sexual function (SAQ), functional status (SF-12), quality of life (The Stoma-QOL), satisfaction with decision (SWD) and an investigator-designed survey at baseline, 6, and 12months after PE. Mann-Whitney and Wilcoxon signed-rank tests were used to evaluate the data. ResultsFifty-four women enrolled. Median age was 56years (31, 85). Median BMI was 30.7kg/m2 (16.8, 54.4). The majority of patients (78%) were white. Cancer diagnoses included 41% cervix, 22% uterus, 19% vagina, 17% vulva and 2% ovary. Most surgeries were total PEs (76%).Patients were satisfied with their decision to undergo PE at 6 and 12months. One year after exenteration, 79% of women stated they would have a PE again. Sexual pleasure decreased from baseline to 12months after PE (p=0.02), while sexual discomfort remained unchanged (p=0.42). Body image worsened over time (p=0.003). Physical functioning (SF-12) declined (p=0.001), while mental functioning remained stable (p=0.46). There were no significant changes in stoma-related QOL, social support, or depression scores. ConclusionsDespite a decrease in physical functioning, persistent low body image and sexual pleasure, most women were satisfied with their decision and would undergo pelvic exenteration again. This study identifies survivorship issues that should be addressed after PE.

Examining the Psychosocial Impact of Genetic Testing for Cardiomyopathies.

Inherited cardiomyopathies, including hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), are the most common monogenic cause of cardiac disease and can rarely lead to sudden cardiac death (SCD). They are characterized by incomplete and age-dependent penetrance and are usually initially symptomatic in adulthood yet can present in childhood as well. Over 20 genes have been identified to cause HCM, and more than 40 genes are known to cause DCM. Genetic testing for these genes has been integrated into medical care; however, the psychological impact of genetic testing and the impact of the uncertainty that comes with receiving these results have not been well studied. This study surveyed 90 adult probands and relatives with a personal or family history of cardiomyopathy from a single hospital-based cardiac genetic program to determine the psychosocial impact of genetic testing for cardiomyopathies. Standardized psychological instruments including an adapted Multidimensional Impact of Cancer Risk Assessment (aMICRA), Impact of Event Scale (IES), and Satisfaction with Decision (SWD) scales were utilized. Patients with positive genetic test results had higher scores for intrusive thoughts, avoidance, and distress when compared to those with negative genetic test results and were also more likely to make or plan to make life changes because of the results of their genetic testing. Satisfaction with the decision to undergo genetic testing was similar regardless of genetic test results. The results of this study provide insight into the patient experience of genetic testing for cardiomyopathies and how these experiences are associated with genetic test results and cardiac history.

Prospective evaluation of quality of life and sexual functioning after radical trachelectomy for early-stage cervical cancer

Objectives: To longitudinally assess quality of life (QOL), sexual functioning, and satisfaction with healthcare decisions in women who have undergone radical trachelectomy for early-stage cervical cancer.Methods: After institutional review board approval, we prospectively enrolled patients with stage IA1-IB1 cervical cancer before undergoing radical trachelectomy to complete validated instruments to assess QOL. These instruments included the General Health-Related QOL (SF-12), the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx), the MD Anderson Symptom Inventory (MDASI), Female Sexual Functioning Index (FSFI), and Satisfaction with Decision (SWD) scale. Instruments were filled out preoperatively (baseline), 4 to 6 weeks postoperatively, at 6 months, at 1 year, and annually thereafter for 4 years. Mixed modeling was used to test for changes from baseline for the survey instruments. A subanalysis was performed comparing QOL scores based on surgical approach.xResults: Thirty-nine patients enrolled in the study, and 35 patients were evaluable. Four patients were excluded because of conversion to radical hysterectomy or limited study participation time. Median age was 30.8 years (range, 21.4–38.7). Median body mass index was 25 kg/m2 (range, 16.1–44.4). Most patients had stage IB1 disease (51%) and underwent robotic radical trachelectomy (69%). The FSFI-arousal (P = .0001), FSFI-lubrication (P < .0001), FSFI-orgasm (P = .0012), FSFI-satisfaction (P = .02), and FSFI-total (P = .002) showed a significant decline at the 4- to 6-week postoperative visit then returned to baseline levels by 6 months. Similarly, the FACT-Cx physical well-being (P < .0001), FACT-Cx social well-being (P < .0001), SF-12 bodily pain (P < .0001), SF-12 physical functioning (P < .0001), SF-12 physical role (P < 0.0001), and SF-12 social functioning (P = .0002) showed a significant decline at the 4-to 6-week postoperative visit then returned to baseline by 6 months. There were no differences in the MDASI or SWD over the follow-up period. There were no differences in QOL scores based on an open versus minimally invasive surgical approach.Conclusions: Several QOL, sexual, and functional assessments decline immediately postoperatively after radical trachelectomy. However, they return to baseline measures by 6 months postoperatively, affording these patients long-term satisfaction with their procedural outcomes regardless of surgical approach. Objectives: To longitudinally assess quality of life (QOL), sexual functioning, and satisfaction with healthcare decisions in women who have undergone radical trachelectomy for early-stage cervical cancer. Methods: After institutional review board approval, we prospectively enrolled patients with stage IA1-IB1 cervical cancer before undergoing radical trachelectomy to complete validated instruments to assess QOL. These instruments included the General Health-Related QOL (SF-12), the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx), the MD Anderson Symptom Inventory (MDASI), Female Sexual Functioning Index (FSFI), and Satisfaction with Decision (SWD) scale. Instruments were filled out preoperatively (baseline), 4 to 6 weeks postoperatively, at 6 months, at 1 year, and annually thereafter for 4 years. Mixed modeling was used to test for changes from baseline for the survey instruments. A subanalysis was performed comparing QOL scores based on surgical approach. xResults: Thirty-nine patients enrolled in the study, and 35 patients were evaluable. Four patients were excluded because of conversion to radical hysterectomy or limited study participation time. Median age was 30.8 years (range, 21.4–38.7). Median body mass index was 25 kg/m2 (range, 16.1–44.4). Most patients had stage IB1 disease (51%) and underwent robotic radical trachelectomy (69%). The FSFI-arousal (P = .0001), FSFI-lubrication (P < .0001), FSFI-orgasm (P = .0012), FSFI-satisfaction (P = .02), and FSFI-total (P = .002) showed a significant decline at the 4- to 6-week postoperative visit then returned to baseline levels by 6 months. Similarly, the FACT-Cx physical well-being (P < .0001), FACT-Cx social well-being (P < .0001), SF-12 bodily pain (P < .0001), SF-12 physical functioning (P < .0001), SF-12 physical role (P < 0.0001), and SF-12 social functioning (P = .0002) showed a significant decline at the 4-to 6-week postoperative visit then returned to baseline by 6 months. There were no differences in the MDASI or SWD over the follow-up period. There were no differences in QOL scores based on an open versus minimally invasive surgical approach. Conclusions: Several QOL, sexual, and functional assessments decline immediately postoperatively after radical trachelectomy. However, they return to baseline measures by 6 months postoperatively, affording these patients long-term satisfaction with their procedural outcomes regardless of surgical approach.

Improvement in quality of life after robotic surgery results in patient satisfaction

BackgroundThere are well-described benefits to minimally invasive surgery including decreased blood loss, shorter hospital-stay, and faster recovery. The role of robotic surgery in gynecologic oncology has become increasingly prominent; however limited data are available on quality of life (QOL) after robotic surgery. MethodsIn this prospective, IRB-approved study, women scheduled for robotic surgery for a gynecologic indication between May 2008 and February 2012 completed validated QOL measures at baseline, 6weeks (6wk), and 4months postoperative (4mo). Functional status (SF-12), symptom severity and interference (MDASI), sexual function (FSFI), and satisfaction with decision (SWD) were assessed at relevant time points. Differences between groups were evaluated using the Mann–Whitney test. ResultsAmong 408 women who underwent robotic surgery 278 (68%) completed the QOL measures. Median age was 55.6years (range 25.7–85.1). Median BMI was 31.3kg/m2. The majority of patients were white (75%). The most common indication for surgery was endometrial cancer/hyperplasia (59.7%). While physical functioning declined from baseline to 6wk (51.4 to 41.6, p<0.001), it improved by 4mo (53.5). Mental functioning improved over time (baseline 48.6, 6wk 52.8, and 4mo 55.6, p<0.001). Symptom severity decreased over time (p<0.001) as did symptom interference (p<0.001). Sexual function improved significantly from baseline (8.6) to 4mo (20.2, p<0.001). Patients were satisfied with their decision making (SWD=30). ConclusionIn this prospective study, general health, symptom burden and sexual function returned to or improved beyond baseline levels within 6weeks of surgery. Overall, women were satisfied with their decision to undergo robotic surgery.

Longitudinal quality of life (QOL) and sexual functioning in women undergoing pelvic exenteration for gynecologic malignancies.

5608 Background: Pelvic exenteration (PE) is en bloc resection of the pelvic organs including bladder, vagina, and rectum to treat central recurrence of a gynecologic malignancy. While this procedure has high morbidity, it is the only option for cure in some patients. The goal of this study was to assess QOL and sexual functioning in women who underwent PE with vaginal and/or bladder reconstruction. Methods: All patients were enrolled prior to PE. Surveys included the SF-12 (functional status), BIS (body image), SAQ (sexual functioning), SWD (satisfaction with decision), CES-D (depression), Stoma QOL, and DUFSS completed preoperatively (preop) and post-operatively at 4-6 wks, 6 mo, 1 yr, and 2 yrs. Descriptive statistics, chi-square, Mann-Whitney, and Kruskal Wallis tests were used to evaluate the data. Results: Between 2008 and 2012, 39 women participated. Median age was 56.7 yrs. Mean physical functional status scores (SF-12) declined through 6 mo postop, with improvements at 1 and 2 yrs (p=.002) but did not reach preop levels. SF-12 mental functioning scores declined immediately postop but returned to baseline by 6 mo. BIS was significantly worse at 1ys (p=0.02) and 2 yrs (p=0.025). Mean depression (CES-D) scores decrease but remained above the clinical cutoff of 17 at 6 mo. Poor sexual function was noted preop and did not improve. High scores for social support (DUFSS) remained constant. Stoma QOL improved in the first 2 yrs but not significantly. Pts reported high satisfaction with the decision to undergo PE, which did not change over time. Conclusions: While a majority of women remained satisfied with their decision to undergo PE, the procedure was associated with depression, worsening physical functioning and poor body image despite stable social support. Interventions are currently under development to improve QOL in this patient population. [Table: see text]

Predictors of satisfaction with decision in patients with advanced cancer.

9045 Background: Treatment decisions in palliative cancer care depend on various patient-, treatment, and disease-related factors. This study investigated patients’ satisfaction with decision and decision-making preferences in a Swiss oncology network and evaluated factors that predict satisfaction with decision (SWD). Methods: Patients receiving a new line of palliative cancer treatment completed a multi-dimensional questionnaire 4-6 weeks after treatment decision. Patient-reports comprised socio-demographic information, satisfaction with decision (primary endpoint), subjective treatment goal, preferences for decision-making, health, locus of control, and several quality of life (QoL) domains. Information on diagnosis, line of therapy, metastases, prognosis, performance status and duration of consultation were provided by the attending physician. Predictors of SWD (range: 0=worst; 30=best) were evaluated by uni- and multivariate (primary analysis, 80% power, 5% significance level) regression models. We consider ≥24 points as high SWD. Results: 445 out of 480 patients treated in 8 hospitals and 2 private practices completed all questions regarding the primary endpoint. 44% of patients preferred shared-, 42% physician-centered decision making. Median duration of consultation was 30 minutes (range 10-200 minutes). Overall, 326 (73%) patients reported high SWD. In univariate analyses various factors (e.g. global and physical QoL, performance status, treatment goal, locus of control, prognosis and duration of consultation) were significant predictors of SWD. The only significant predictor in the multivariate analysis was duration of consultation, which was positively associated with SWD (p=0.01). Conclusions: SWD is generally high in patients with advanced cancer treated in an oncology network in Switzerland. Our results indicate that duration of consultation is a very important factor among many others in predicting SWD. In busy clinical practice, taking your time with patients may be a simple measure to enhance patients’ SWD.

Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey

ObjectiveThe purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations. MethodsA randomly selected age-proportionate national sample of adults (aged 21–70 years) stratified on race, ethnicity, and gender (N=488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the Shared Decision Making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD. ResultsAfter controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R2=.368, p<.001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD. ConclusionSDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly. Practice implicationsBy identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes.

Satisfaction with ovarian carcinoma risk‐reduction strategies among women at high risk for breast and ovarian carcinoma

Women who are at high risk for breast and ovarian cancer have 2 major management options to reduce their risk of ovarian cancer: periodic screening (PS) or risk-reducing salpingo-oophorectomy (RRSO). Little is known regarding patient satisfaction levels with risk-reduction strategies. Thus, the authors sought to determine levels of patient satisfaction with PS versus RRSO and to identify factors that may influence satisfaction. As part of a larger study, women who received testing for the breast cancer genes BRCA1 and BRCA2 were sent a follow-up questionnaire packet to explore issues related to cancer risk reduction. The authors report on the results from a variety of validated instruments, including the Satisfaction With Decision (SWD) scale, focused on the choice between PS and RRSO. In total, 544 surveys were mailed, and 313 responses were received (58%). The overall satisfaction rate among respondents was high. The median SWD score was significantly higher in the RRSO group compared with the PS group (P < .001). BRCA mutation carriers had higher median SWD scores regardless of management type (P = .01). Low satisfaction scores were associated with high levels of uncertainty and the perception that the decision between PS and RRSO was difficult to make (P = .001). Satisfaction was unrelated to demographics, clinical factors, or concerns of cancer risk. In the current study, the majority of women who were at high risk for breast and ovarian cancer were satisfied with their choice of risk-reduction strategy. Difficulty with decision making was associated with lower satisfaction levels. Improved education and support through the decision-making process may enhance overall levels of satisfaction.

Management strategies for women at high risk for breast and ovarian cancer: Are women satisfied?

1524 Background: Women at high risk for breast and ovarian cancer have two major management options to reduce their risk of ovarian cancer, periodic screening (PS) or prophylactic oophorectomy (PO). Little is known regarding patient satisfaction levels with choice of risk reduction strategy. Our objective was to determine levels of patient satisfaction with PO versus PS and to identify factors which may influence satisfaction. Methods: As part of a larger study, women who received BRCA1/2 testing before July 2005 were sent a follow-up patient questionnaire packet. We are reporting on the Cancer Worry Scale and Satisfaction With Decision (SWD) scale (range of possible scores, 6–30). The lowest 10th percentile of the SWD score (21) was used to define low satisfaction. Chi-square, t-Test and Mann-Whitney tests were used for statistical analyses. Results: A total of 540 surveys were mailed and 309 responses were received (57%). We excluded 127 patients due to history of an oophorectomy for benign or malignant indications or incomplete SWD scale. The median age of respondents was 48.2. 60/182 women (33%) had BRCA mutations and 64/182 (35.2%) underwent PO. The overall satisfaction rate among respondents was high (median score 29, range 14–30). Median SWD score was significantly higher in patients in the PO group compared to the PS group (30.0 vs. 26.5, p&lt;.001). Patients with BRCA mutations had higher median SWD scores, regardless of management type (30.0 vs. 28.0, p=.013). Low satisfaction scores were associated with the perception that the decision between PO and PS was difficult to make (p=.001). Patients who expressed ongoing difficulty in their decision-making also had lower satisfaction scores (p=.016). Satisfaction was unrelated to demographics, clinical factors, or concerns of cancer risk. Conclusions: In our study, the majority of women at high risk for breast and ovarian cancer were satisfied with their choice of risk reduction strategy. In particular, women who chose PO had higher levels of overall satisfaction. Difficulty with decision-making was associated with lower satisfaction levels. Improved education and support of these women through the decision-making process may enhance overall levels of satisfaction with risk reduction strategy. No significant financial relationships to disclose.

Exploring the Subconcepts of the Wittmann‐Price Theory of Emancipated Decision‐Making in Women's Health Care

To explore the subconcepts of the Wittmann-Price Theory of Emancipated Decision-Making (EDM); which is proposed as a new theoretical model for the nursing care of women to increase women's satisfaction with decision-making about healthcare issues. Infant feeding method was used as the clinical exemplar. A descriptive correlational design was used to test the five identified subconcepts of EDM (empowerment, flexible environment, personal knowledge, reflection, and social norms) in women's healthcare. The relationship of emancipated decision-making and satisfaction were explored with the Subject Demographic Questionnaire (SDQ), the Wittmann-Price Theory of Emancipated Decision-making Scale (EDMS), and the Satisfaction with Decision (SWD) scale. The research design was retrospective, without random sampling of subjects. Four research questions were posed for this investigation. Women who had uncomplicated deliveries and met the selected criteria were enrolled (N=97). All five subconcepts of EDM were scored on subscales on the EDMS; flexible environment and personal knowledge had the highest mean scores. Pearson correlations showed that all five subscales were significantly related to each other except reflection with personal knowledge and reflection with social norms. A significant relationship was found between the EDM and satisfaction with the decision. Personal knowledge and flexible environment were the best predictors of satisfaction with the decision. The Wittmann-Price Theory of EDM is a theoretical model with implications for nursing care of women who are involved in a healthcare decision, such as choice of infant feeding. Further studies are needed to determine the importance of each of the subconcepts in relation to emancipated decision-making.

Satisfaction with the decision to participate in cancer clinical trials (CCT) is high, but understanding is a problem

6067 Background: We aimed (a) to assess patient (pt) knowledge about CCT and satisfaction with decision (SWD) to participate, (b) to determine whether satisfaction correlates with objective understanding of CCT or other factors and (c) to identify correlates of increased understanding, for example with demographic data, method of giving informed consent (IC), anxiety, depression and QOL. Methods: Convenience sample of 100 pts from CCT auspiced by Cancer Trials Australia. Eligibility - signed IC, enrolment on a therapeutic CCT within the preceding week, age ≥ 18 years. Instruments assessed quality of IC (QuIC), QOL (EORTC QLQ C-30), anxiety and depression (HADS), and preferences for information and involvement in decision-making. Measures were completed within 2 weeks of clinical trial enrolment. Results: 102 pts (67 male), median age 57.9 (29–85). 27 CCT - phase I/II/III - 6/10/11. Median QuIC objective knowledge score (QuIC-A) was 77.5 (/100) and perceived (subjective) understanding (QuIC-B) 91.4. Some questions were consistently answered poorly. There was low but significant correlation between QuIC-A and B (R=0.28, p=0.004). SWD was high. Correlation between QuIC-B and SWD was moderate (0.423, p<0.001). Correlations between SWD and each of QuIC-A, anxiety (HADS-A) and depression (HADS-D) were low and not significantly different from zero. Correlation between HADS-A and HADS-D was moderately high (0.680, p<0.001). Higher objective knowledge (QuIC-A) was associated with female sex, English as a 1st language (EFL), university education and lower HADS-D scores, but not with delayed decision-making, self-assessment of global health status, phase of trial or with easier to read consent forms. Higher QuIC-B scores were associated with low-level education, EFL and higher assessment of health, but not with gender, delayed decision, HADS-D or phase of trial. Conclusions: Overall, pt knowledge regarding CCT is reasonable (and similar to published US data) and satisfaction is very high. Satisfaction is correlated with perceived, but not with objective understanding. Strategies to improve pt understanding of CCT need to be developed. No significant financial relationships to disclose.

Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients.

To conduct a preliminary validation of the Satisfaction With Decision (SWD) scale with depressed primary care patients. Cross-sectional observational pilot study using a postal survey. Depressed primary care patients (n = 97) who recently had made a new decision about antidepressant medication use completed surveys regarding their treatment decisions. Measures included patient-reported satisfaction with decision, decisional conflict, knowledge about depression and treatment, decision involvement, pain and health status, antidepressant medication efficacy, and satisfaction with health services. The SWD scale had good internal consistency reliability (alpha = 0.85). Evidence for construct validity was confirmed via a hypothesized pattern of relationships between the SWD scale and other measures. Decision satisfaction was associated with several issues of relevance for designing patient-centred decision support interventions: (1) knowledge about depression and treatment; (2) involvement in health-related decisions; and (3) aiding evaluation of trade-offs among pros and cons of treatment. The results of this pilot study show that the SWD scale appears to be a psychometrically sound and practical measure for research with this population. Additional research is needed on the theoretical nature of decision satisfaction and developing and testing patient-centred decision support interventions for depression treatment.

The development of COMRADE—a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations

Some instruments have been developed to evaluate ‘decision effectiveness’ such as the ‘satisfaction with decision (SWD)’ and ‘decision conflict (DCS)’ scales and are validated for the US context. Patients identify further outcome domains that are not fully covered in these scales. We developed a patient-based outcome measure to evaluate risk communication and decision making effectiveness, addressing these further domains and validated for use in the UK. Formulation of items was based on literature review and key informant interviews. The instrument was piloted and developed (including psychometric assessment) in the context of a trial of decision making and risk communication interventions in general practice. Patients were recruited to the trial with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms. High response rates (96% in first phase) indicated acceptability to patients. A 20 item patient-based outcome measure, with two sub-scales for ‘risk communication’ and ‘confidence in decision’, was produced. It allows for paternalistic, shared or informed choice decision making models. Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer.

Can patient satisfaction with decisions predict compliance with surgery?

Patient satisfaction with treatment decisions is a discrete and measurable component of the satisfaction paradigm, distinct from satisfaction with health care services. The study goal was to determine if the Satisfaction With Decision (SWD) scale, a valid and reliable 6-item survey, can predict patient compliance with surgery proposed by their otolaryngologist. Prospective study using the SWD scale plus measures of office visit satisfaction, provider satisfaction, and disease-specific quality of life. Metropolitan, private nonprofit hospital. The study population consisted of 151 patients scheduled for surgery, with a median age of 5.8 years and an age range of 0.6 to 65.3 years. At the time surgery was scheduled, the decision-maker completed a 12-item questionnaire about satisfaction and quality of life that included the SWD scale. Noncompliant patients were contacted, and the specific reason for cancellation was ascertained. The strongest predictor of surgical cancellation was the SWD survey score, with a median value of 4.8 for patients completing surgery compared with 3.8 for those who cancelled (P < 0.001). Patients with scores <4.0 had a 57% cancellation rate, whereas those with scores > or =4.0 had a 98% completion rate. Patients were also more likely to cancel if it was their first visit with the surgeon (P = 0.004) or if they were responsible for their own decisions (P = 0.007). Cancellations were not associated with office visit satisfaction, patient quality of life, or demographic characteristics of the decision-maker. Patients who are satisfied with their initial decision to undergo surgery are most likely to comply with planned therapy. Conversely, patients who score <4.0 on the SWD scale may benefit from additional preoperative counseling to increase the likelihood of compliance.