Total Decisional Conflict Scale Score Research Articles

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

BackgroundAdvances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China.MethodsThis was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist.ResultsThe study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group.ConclusionThe use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.

A pilot randomized controlled study to determine the effectiveness of video educational tool in BRCA1/2 pre‐test counseling for Japanese breast cancer patients

AbstractBRCA1/2 genetic testing has become clinically important in breast cancer care, but increasing demand may put a burden on the shortage of healthcare professionals. We performed a single‐center, pilot randomized controlled study to assess the effectiveness of employing a video educational tool that included standard pre‐test genetic counseling elements related to BRCA1/2. Patients with operable breast cancer who met the criteria for genetic testing based on age, sex, subtype, and family history were recruited. Sixty consenting participants were randomized 1:1 and placed in groups that received either traditional face‐to‐face pre‐test counseling or video‐viewing and face‐to‐face decisional support. To assess decisional conflict in the participants, surveys based on the Decisional Conflict Scale (DCS) were administered two times, once immediately after intervention and again 2–4 weeks later. The time taken for counseling and confirmation of whether the participants had undergone testing were also recorded. The difference in the total DCS scores between the two groups was not significantly different for either of the survey periods, and there was no significant difference in the number of participants who underwent testing (23/30 [76.7%] vs. 26/30 [86.7%]; p = 0.51). However, the “effective decision” subscale score was significantly higher in the video group 2–4 weeks after counseling (31.01 ± 16.82 vs. 21.43 ± 16.09; p = 0.04 [mean ± SD]). The time taken for counseling was significantly shorter in the video group (8.00 ± 4.5 vs. 27.00 ± 7.61 min; p < 0.001 [median ± SD]). Our findings indicate the potential benefit of the video educational tool for providing BRCA1/2‐related information. These tools may also enable healthcare professionals to spend more time supporting psychological issues. Notably, after some time, patients may question whether their decision was appropriate. Therefore, it is necessary to identify those in conflict and provide them with proper support.

Evaluation of a decision aid for early pregnancy loss: A pilot randomized controlled trial in Philadelphia, Pennsylvania

ObjectivesTo evaluate the effect of a decision aid on decisional conflict scale in patients choosing management for early pregnancy loss. Study designWe conducted a pilot randomized control trial to assess the effect of the Healthwise patient decision aid on decisional conflict scale in patients with early pregnancy loss as compared with a control website. Patients 18years and older were eligible if they had an early pregnancy loss between 5 and 12 completed weeks of gestation. Participants completed surveys at baseline, poststudy intervention, after consultation, and 1week postconsultation. Surveys assessed participant scores on the decisional conflict scale (scale 0–100), knowledge, assessment of shared decision-making, satisfaction, and decision regret. Our primary outcome was the poststudy-intervention decisional conflict scale score. ResultsFrom July 2020 through March 2021 we randomized 60 participants. After the intervention, the median decisional conflict scale score for the control group was 10 [0–30] and 0 [0–20] for the intervention group (p = 0.17). When assessing the decisional conflict scale subscales postintervention, the informed subscale for the control group was 16.7 [0–33.3] as opposed to 0 [0] for the patient decision aid group (p = 0.003). Knowledge remained significantly higher in the experimental arm from the postintervention to the 1-week follow-up. We found no differences between groups when assessing our other metrics. ConclusionsUse of a validated decision aid did not result in statistically significant differences in the total decisional conflict scale scores as compared with the control. Participants allocated to the intervention were more informed postintervention and had consistently higher knowledge scores. ImplicationsUse of a validated decision aid prior to early pregnancy loss management consultation did not affect overall decisional conflict but resulted in improved knowledge.

Randomized Pilot Test of a Decision Support Tool for Acute Appendicitis: Decisional Conflict and Acceptability in a Healthy Population.

Mounting evidence from randomized controlled trials have shown that antibiotics can be a safe and effective treatment for appendicitis. Patients and surgeons must work together to choose the optimal treatment approach for each patient based on their own preferences and values. We developed a decision support tool to facilitate shared decision-making for appendicitis and its effect on decisional outcomes remains unknown. We conducted an online randomized field test in at-risk individuals comparing the decision support tool to a standard infographic. Individuals were randomized 3:1 to view the decision support tool or infographic. The primary outcome was the total decisional conflict scale (DCS) score measured before and after exposure to the decision support tool. Secondary outcomes included between-group DCS scores, and between-group comparisons of the acceptability. One hundred eighty individuals were included in the study. Total DCS scores decreased significantly after viewing the decision support tool (59 [95% confidence interval (CI): 55-63] to 15 [95% CI: 12-17], P < 0.001) representing movement from a state of high to low decisional conflict. Individuals exposed to the decision support tool reported higher acceptability ratings (3.7 [95% CI: 3.6-3.8] vs 3.3 [95% CI: 3.2-3.5] out of 4) and demonstrated increased willingness to consider both treatment options. These data support the further use and testing of this novel decision support tool in patients with acute appendicitis.

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.

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.

PATIENT EDUCATIONAL NEEDS AND TREATMENT PREFERENCES FOR HEART FAILURE MEDICATIONS

BACKGROUND High-quality evidence supports the use of several medications for heart failure (HF) with reduced ejection fraction, yet their use remains low. Shared decision-making (SDM) tools, such as decision aids, can bridge evidence-to-practice gaps and improve the integration of patient preferences to facilitate patient-centred care. At present, however, little is known about the preferences and decisional needs of patients regarding these medications. The aim of this study was to characterize the education needs and treatment preferences of people with HF to facilitate shared decision-making. METHODS AND RESULTS We surveyed 52 Canadians living with HF from February-March 2021 who were members of the HeartLife Foundation support group. The survey instrument included questions on (1) demographics and HF characteristics, (2) decisional needs assessment, and (3) patient treatment preferences. Decisional conflict was measured using the low-literacy 10-item Decisional Conflict Scale (DCS). DCS scores range from 0-100, with scores < 25 and >37.5 associated with implementing and delaying decisions, respectively. Respondents had a median age 63 years and ejection fraction 40%, 74% were women, and 83% were white. Most participants (58%) reported playing a passive role in previous HF medication decisions, whereas 27% and 15% reported an active or collaborative role, respectively. Median total DCS score was 60, with 25% of scores indicative of decisional implementation and 63% indicative of decisional delay. DCS sub-scores indicated greatest decisional conflict in the “informed” sub-score (67) and least decisional conflict in the “support” sub-score (33). Most treatment attributes were ranked as highly important considerations in decision-making, with mean scores >8/10 for all attributes except cost (7.5/10), increased lab test frequency (5.8/10), and additional pill burden (4.5-6/10). Most respondents wished to received information on their HF medications from their HF specialists (98%), general practitioners (69%) and pharmacist (54%). CONCLUSION In this study of people living with HF, most respondents reported playing a passive role in decisions regarding their HF medications. Most patients felt at least a moderate amount of decisional conflict regarding their HF medications, mostly from feeling uninformed about available options and their related benefits and risks. Decision aids that address these information gaps may facilitate SDM and improve decision quality. High-quality evidence supports the use of several medications for heart failure (HF) with reduced ejection fraction, yet their use remains low. Shared decision-making (SDM) tools, such as decision aids, can bridge evidence-to-practice gaps and improve the integration of patient preferences to facilitate patient-centred care. At present, however, little is known about the preferences and decisional needs of patients regarding these medications. The aim of this study was to characterize the education needs and treatment preferences of people with HF to facilitate shared decision-making. We surveyed 52 Canadians living with HF from February-March 2021 who were members of the HeartLife Foundation support group. The survey instrument included questions on (1) demographics and HF characteristics, (2) decisional needs assessment, and (3) patient treatment preferences. Decisional conflict was measured using the low-literacy 10-item Decisional Conflict Scale (DCS). DCS scores range from 0-100, with scores < 25 and >37.5 associated with implementing and delaying decisions, respectively. Respondents had a median age 63 years and ejection fraction 40%, 74% were women, and 83% were white. Most participants (58%) reported playing a passive role in previous HF medication decisions, whereas 27% and 15% reported an active or collaborative role, respectively. Median total DCS score was 60, with 25% of scores indicative of decisional implementation and 63% indicative of decisional delay. DCS sub-scores indicated greatest decisional conflict in the “informed” sub-score (67) and least decisional conflict in the “support” sub-score (33). Most treatment attributes were ranked as highly important considerations in decision-making, with mean scores >8/10 for all attributes except cost (7.5/10), increased lab test frequency (5.8/10), and additional pill burden (4.5-6/10). Most respondents wished to received information on their HF medications from their HF specialists (98%), general practitioners (69%) and pharmacist (54%). In this study of people living with HF, most respondents reported playing a passive role in decisions regarding their HF medications. Most patients felt at least a moderate amount of decisional conflict regarding their HF medications, mostly from feeling uninformed about available options and their related benefits and risks. Decision aids that address these information gaps may facilitate SDM and improve decision quality.

Pilot Study of an Encounter Decision Aid for Lung Cancer Screening.

The Centers for Medicare and Medicaid Services has mandated in-person shared decision-making (SDM) counseling with the use of one or more decision aids (DAs) prior to lung cancer screening. We developed a single-page, paper-based, encounter DA (EDA) to be used within a clinician-patient encounter for lung cancer screening and conducted a pre-post pilot intervention study to evaluate its feasibility and effects on patient decisional conflict. Patients referred to a pulmonary practice-based lung cancer screening program were surveyed before and after an SDM visit with a pulmonologist, who used the EDA to counsel the patient. Patient knowledge of the mortality benefit from screening and the frequency of abnormal screening test results was evaluated after the visit, while decisional conflict was measured before and after the visit using the Decisional Conflict Scale (DCS). Twenty-three patients participated (mean age = 65.8years; 43% female; mean smoking history = 57.8pack-years; 48% currently smoking). Following the visit, 28% of participants correctly understood the mortality benefit of lung cancer screening, while 82% understood the frequency of abnormal screening tests. The mean total DCS score decreased from 35.0 to 0.2 after the visit (p < 0.001). These data suggest that a single-page, paper-based EDA is feasible and potentially effective in reducing decision conflict when used within a SDM visit, although more research is needed to establish the independent effects of the EDA, and future efforts to promote SDM may need to devote greater attention to improving patient understanding of the mortality benefit of screening.

20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework

Introduction. The Ottawa Decision Support Framework (ODSF) has guided practitioners and patients facing difficult decisions for 20 years. It asserts that decision support interventions that address patients' decisional needs improve decision quality. Purpose. To update the ODSF based on a synthesis of evidence. Methods. We conducted an overview of systematic reviews, searching 9 electronic databases. Eligible reviews included decisional needs assessments, decision support interventions, and decisional outcome measures guided by the ODSF. We extracted data and synthesized results narratively. Eight ODSF developers/expert users from 4 disciplines revised the ODSF. Results. Of 4656 citations, we identified 4 eligible reviews (>250 studies, >100 different decisions, >50,000 patients, 18 countries, 5 continents). They reported current ODSF decisional needs and their most frequent manifestations in the areas of inadequate knowledge/information, unclear values, decisional conflict/uncertainty, and inadequate support. They uncovered 11 new manifestations of 6 decisional needs. Using the Decisional Conflict Scale (DCS) to assess decisional needs, average scores were elevated at baseline and declined shortly after decision making, even without information interventions. Patient decision aids were superior to usual care in reducing total DCS scores and improving decision quality. We revised the ODSF by refining definitions of 6 decisional needs and adding new interventions to address 4 needs. We added a decision process outcome and eliminated secondary outcomes unlikely to improve across a range of decisions, retaining the implementation/continuance of the chosen option and appropriate use/costs of health services. Conclusions. We updated the ODSF to reflect the current evidence and identified implications for practice and further research.

Shared decision-making in older children and parents considering elective adenotonsillectomy.

Shared decision-making describes a collaborative process in which healthcare providers and patients/families make treatment decisions using the best available evidence, while taking into account the patient's values and preferences. The objectives of this study were to assess the level of decisional conflict and shared decision-making experienced by older children and their parents when considering elective adentonsillectomies. A prospective cohort study. Paediatric otolaryngology clinic in a teaching hospital. Participants included 53 children older than 9years and their parents who underwent consultation for tonsillectomy with or without adenoidectomy. Children and parents completed the Decisional Conflict Scale (DCS) and Shared Decision-Making Questionnaire-Patient Version (SDM-Q-9). Surgeons completed the Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc). Overall, 10 (19%) parents and 18 (34%) children reported clinically significant decisional conflict. Parents who opted not to proceed with surgery had significantly higher DCS scores than those who decided to proceed with surgery. Both parents and children SDM-Q-9 and total DCS scores were significantly negatively correlated. Physician SDM-Q-Doc and parent total DCS scores were negatively correlated, while parent and physician SDM scores were positively correlated. Many older children and parents reported significant decisional conflict when considering elective paediatric otolaryngology surgery. Decisional conflict levels for both children and parents decreased with greater perceived levels of shared decision-making. Older children did not appear to discern the same levels of shared decision-making as parents and surgeons. Future research should assess methods to implement shared decision-making into clinical practice for clinicians, parents and children when appropriate.

Development, validation and initial evaluation of patient-decision aid (SUI-PDA\xa9) for women considering stress urinary incontinence surgery

Introduction and hypothesisFollowing the design, face validation and publication of a novel PDA for women considering SUI surgery, the main objective of the study is to evaluate the usefulness of SUI-PDA© by using a validated tool to obtain patient feedback.MethodsFrom July 2018 to March 2019, the PDA, already incorporated into the patient care pathway, was objectively evaluated using the Decisional Conflict Scale (DCS) to determine patients’ views. Patients recorded their values and reasons for requests and declines of treatment. The total DCS score, scores from each DCS subgroup and individual patient responses were calculated and analysed.ResultsThe mean age of the first 20 patients to complete the DCS was 54 years, the mean BMI was 30.1 and the median parity was 3. The average total DCS score was only 9.29 out of 100 (range 0–29.69) suggesting that the PDA was quite useful for patients considering SUI surgery. Overall, the PDA had largely favourable responses across all five DCS subgroups. The ‘informed’ subgroup had the best score (6.67) while the ‘uncertainty’ subgroup had the least favourable score (14.58). Despite the procedure pause, the mesh tape option remained on the PDA; however, no patient had chosen this option, with a large proportion citing ‘safety’ issues as the main reason. Bulking agent injections were the most popular choice (40.0%) and the most commonly performed procedures (50.0%) mainly because of quicker ‘recovery’. The second most popular participant choice was colposuspension (35.0%) followed by autologous fascial sling (25.0%), with women citing ‘efficacy’ as the main reason behind their choice.ConclusionSUI-PDA© was reported by patients and clinicians to be useful with clinical decision-making for SUI surgery. Further validation in a larger patient group is underway.

Decisional Conflict Scale Findings among Patients and Surrogates Making Health Decisions: Part II of an Anniversary Review.

Background. We explored decisional conflict as measured with the 16-item Decisional Conflict Scale (DCS) and how it varies across clinical situations, decision types, and exposure to decision support interventions (DESIs). Methods. An exhaustive scoping review was conducted using backward citation searches and keyword searches. Eligible studies were published between 1995 and March 2015, used an original experimental/observational research design, concerned a health-related decision, and provided DCS data. Dyads independently screened titles/abstracts and full texts, and extracted data. We performed narrative syntheses and calculated average or median DCS scores. Results. We included 246 articles reporting on 253 studies. DCS scores ranged from 2.4 to 89.6 out of 100. Highest baseline DCS scores were for care planning (30.5 ± 12.8, median = 30.9) and treatment decisions (30.5 ± 14.6, median = 28.0), in contexts of primary care (33.8 ± 19.8), obstetrics/gynecology (28.8 ± 10.4), and geriatrics (32.6 ± 10.7). Baseline scores were high among decision makers who were ill (29.5 ± 13.8, median = 27.2) or making decisions for themselves (29.7 ± 14.8, median = 26.9). Total DCS scores <25 out of 100 were associated with implementing decisions. Without DESIs, DCS scores tended to increase shortly after decision making (>37.4). After DESI use, DCS scores decreased short-term but increased or remained the same long-term (>6 months). Conclusions. DCS scores were highest at baseline and decreased after decision making. DESIs decreased decisional conflict immediately after decision making. The largest improvements after DESIs were in decision makers who were ill, male, or made decisions for themselves. Meta-analyses focusing on decision types, contexts, and interventions could inform hypotheses about the expected effects of DESIs, the best timing for measurement, and interpretation of DCS scores.

Treatment-related Decisional Conflict, Quality of Life, and Comorbidity in Older Adults with Cancer

Objective:The present study aims to examine the relationships between and among cancer treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer.Methods:A convenience sample of 200 older adults was recruited from outpatient medical oncology and radiation oncology practices in the northeastern United States. A cross-sectional, descriptive, correlational study design was used employing a survey method. Survey instruments included the Decisional Conflict scale (DCS) (with five subscales, including informed, values clarity, support, uncertainty, and effective decision); Self-administered comorbidity questionnaire (SCQ); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (including five function scales, three symptom scales, a global health/quality of life scale, and six single items); and an investigator-developed demographic form.Results:The mean total DCS score was 22.1 (±12.5). The uncertainty subscale had the highest mean of the subscales (29.2 ± 18.2). The mean score for global health status/quality of life was 44.2 (±20.7). The mean score of the SCQ was low (9.6 ± 4.1). Significant positive relationships were identified between decisional conflict and quality of life (P = 0.009) and quality of life and comorbidity (P = 0.001). Multiple linear regression analysis found statistically significant relationships for total decisional conflict score and the five decisional conflict scale subscales.Conclusions:Results may suggest a relationship between decisional conflict and quality of life, as well as the quality of life and comorbidity. In addition, there are several physical, emotional, and spiritual factors that may positively or negatively impact decisional conflict.

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial

Background: In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. Aim: To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Design: Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. Setting/participants: A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. Results: The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (−10.5, 95% confidence interval: −16.4 to −4.7; p < 0.001). Conclusion: Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

Randomized controlled trial of a patient decision-making aid for orthodontics.

Patient decision-making aids (PDAs) are instruments that facilitate shared decision making and enable patients to reach informed, individual decisions regarding health care. The objective of this study was to assess the efficacy of a PDA compared with traditional information provision for adolescent patients considering fixed appliance orthodontic treatment. Before treatment, orthodontic patients were randomly allocated into 2 groups: the intervention group received the PDA and standard information regarding fixed appliances, and the control group received the standard information only. Decisional conflict was measured using the Decisional Conflict Scale, and the levels of decisional conflict were compared between the 2 groups. Seventy-two patients were recruited and randomized in a ratio of 1:1 to the PDA and control groups. Seventy-one patients completed the trial (control group, 36; PDA group, 35); this satisfied the sample size calculation. The median total Decisional Conflict Scale score in the PDA group was lower than in the control group (15.63 and 19.53, respectively). However, this difference was not statistically significant (difference between groups, 3.90; 95% confidence interval of the difference, -4.30 to 12.11). Sex, ethnicity, age, and the time point at which patients were recruited did not have significant effects on Decisional Conflict Scale scores. No harm was observed or reported for any participant in the study. The results of this study showed that the provision of a PDA to adolescents before they consented for fixed appliances did not significantly reduce decisional conflict. There may be a benefit in providing a PDA for some patients, but it is not yet possible to say how these patients could be identified. This trial was registered with the Harrow National Research Ethics Committee (reference 12/LO/0279). The protocol was not published before trial commencement.

Specific Words and Experience Matter to Surrogates When Making End of Life Decisions

ABSTRACTThis grant funded preliminary study investigated the relationship between end-of-life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults aged 50 and older. Participants were randomized into two groups; each received a survey packet that varied only in the use of the words “Do Not Resuscitate (DNR)” and “Allow Natural Death (AND).” The Decisional Conflict Scale (DCS) was administered and demographic data were collected. No difference was found in the total DCS scores based on the AND and DNR versions. However, AND respondents perceived their decision as a good decision and were eight times more likely to sign the document than DNR participants. Experienced decision-makers evolved as a discrete group. They had lower mean total DCS scores and lower mean subscores, indicating that prior experience is an important aspect of end-of-life decision-making. Experienced AND participants were more likely to perceive their decision as good and were more likely to be sure of their decision, indicating that they respond more favorably to the words Allow Natural Death. Respondents to the DNR version were likely to not sign or postpone signing. Those who frequently attended religious services were twice as likely as those who rarely attend religious services of implementing their decision; whether the decision is to sign or not to sign the AND or DNR. Finally, participants were more likely to withdraw from the study when the term DNR was used. Recommendations for future research are presented.

Decision-Making Quality in Parents Considering Adenotonsillectomy or Tympanostomy Tube Insertion for Their Children

ImportanceShared decision making is a process in which clinicians and patients make health care decisions in a collaborative manner using the most up-to-date evidence, while considering patient values and preferences. Shared decision making is thought to have a positive influence on the decision-making process in medicine.ObjectiveTo describe the level of decisional conflict and decisional regret experienced by parents considering surgery for their children and to determine relations among decisional conflict, decisional regret, and shared decision making.Design, Setting, and ParticipantsA prospective cohort study was conducted at an academic pediatric otolaryngology clinic. Participants included 126 parents of children younger than 6 years who underwent consultation for adenotonsillectomy or tympanostomy tube insertion.Main Outcomes and MeasuresParent participants completed the Shared Decision Making Questionnaire–Parent version, Decisional Conflict Scale (DCS), and Decisional Regret Scale (DRS). Surgeons completed the Shared Decision Making Questionnaire–Physician version.ResultsThis study included 126 parents; 102 women (mean [SD] age, 33.2 [5.1] years) and 24 men (mean [SD] age, 35.6 [6.3] years). Overall, 34 parents (26%) reported clinically significant decisional conflict. Only 1 parent experienced moderate to strong decisional regret; 28 parents (43.7%) had mild decisional regret. Both parent and physician ratings of shared decision making were significantly negatively correlated with total DCS scores. Parent SDM-Q-9 and total DCS scores were significantly negatively correlated (rs[118] = −0.582; P < .001). Similarly, physician SDM-Q-Doc and total DCS scores were also significantly negatively correlated (rs[118] = −0.221; P = .04). Only parent ratings of shared decision making were significantly negatively correlated with total DRS scores (rs[63] = −0.254; P = .045). Those parents with clinically significant decisional conflict had significantly higher DRS scores (P = .02).Conclusions and RelevanceMany parents experienced significant decisional conflict when making decisions about their child’s elective surgical treatment. Parents who perceived themselves as being more involved in the decision-making process reported less decisional conflict and decisional regret. Future research should explore the influence of decision quality on health outcomes and develop methods to improve shared decision making.

THE DECIDE STUDY: DEMENTIA CARERS MAKING INFORMED DECISIONS FEASIBILITY RCT

Carers of people with dementia find making decisions for their relatives who no longer have the capacity do so difficult. Deciding whether the person with dementia should move to a care home is especially challenging. We developed DECIDE, a decision aid to consider the options, including care home admission, based on evidence of what helped in these decisions. We consulted with family carers, people with dementia and healthcare professionals and tested it in a randomised controlled trial. We randomised carers who were at the point of deciding where their relative with dementia should live to the DECIDE intervention or treatment as usual (TAU). Our co-primary outcomes were feasibility of recruitment and carers opinions of quality, relevance and usefulness of the intervention. Secondary outcomes were reduction on the ‘informed’ sub-scale of the Decisional Conflict Scale (DCS), total DCS score and anxiety and depression. All measures were completed at baseline, one week and 10 weeks later. We conducted individual qualitative interviews with all 20 carers who received the DECIDE manual to explore impact of the intervention on decision-making. 40 carers (20 DECIDE manual, 20 TAU) participated. Recruitment and qualitative data indicate that the trial was feasible and carers found the decision aid useful and relevant. We will report between group comparisons on study quantitative outcomes post-intervention and at 10 weeks. It is feasible to carry out a trial of a decision aid with family carers of people with dementia about place of care decisions. Our decision aid is acceptable and may be useful for reducing decisional conflict of cares.

Decisional conflict in patients considering diagnostic thyroidectomy with indeterminate fine needle aspirate cytopathology.

BackgroundFine needle aspiration (FNA) cytopathology is the gold standard work-up for thyroid nodules. However, indeterminate lesions are encountered commonly and can lead to difficult treatment decisions. We sought to determine whether patients experienced decisional conflict surrounding management with diagnostic thyroidectomy in the setting of indeterminate FNA results.MethodsPatients with indeterminate results of thyroid nodule FNA were prospectively enrolled. All consultations were carried out by three otolaryngologists in a consistent manner. After consultation, participants completed a demographics form and the Decisional Conflict Scale (DCS) questionnaire.ResultsThirty-five patients (28 female) between the ages of 30 and 88 years (mean age 54.89) participated. The median total DCS score was 10.94 (interquartile range, 4.69–25.0). Twelve patients (34 %) scored at or above 25 on the DCS, indicating clinically significant level of decisional conflict. Patients reported feeling significantly more confident about their decision after the surgical consultation compared to before the consultation (p = 0.00). The total DCS score was significantly negatively correlated with self-reported confidence after the consultation (r = −0.421, p = 0.012).ConclusionMany patients experienced clinically significant decisional conflict when considering thyroidectomy for management of a thyroid nodule with indeterminate cytopathology. Future research should be directed at developing decision support tools for this patient group, and exploring the impact of decisional conflict on health outcomes.