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Decisional conflict

Jennifer Muir, Melyssa Aronson, Mary-Jane Esplen, Aaron Pollett, Carol J Swallow
BACKGROUND: Hereditary diffuse gastric cancer (HDGC) syndrome is caused by germline mutations in the CDH1 gene and carries a lifetime gastric cancer risk of approximately 70 % in men and 56 % in women. Current consensus guidelines recommend that people of age ≥20 who harbor a CDH1 mutation undergo prophylactic total gastrectomy (PTG). However, the decision to proceed with a major visceral resection for prophylactic reasons may be difficult, especially since long-term outcomes are not well defined...
October 17, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ellen A Lipstein, Daniel J Lovell, Lee A Denson, Sandra C Kim, Charles Spencer, Richard F Ittenbach, Maria T Britto
OBJECTIVES: To understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. METHODS: We mailed surveys to parents of children with IBD (inflammatory bowel disease) or JIA (juvenile idiopathic arthritis) who had started treatment with biologics in the prior two years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret...
September 30, 2016: Journal of Pediatric Gastroenterology and Nutrition
Zoe Marshman, Abdussalam Eddaiki, Hilary L Bekker, Philip E Benson
OBJECTIVES: To develop and evaluate a child-centred patient decision aid for young people, and their parents, supporting shared decision making about fixed orthodontic appliance treatment with dental health professionals, namely the Fixed Appliance Decision Aid (FADA). METHODS: The studies were undertaken in a UK teaching dental hospital orthodontic department in 2013-2014. The development phase involved an interview study with: (a) 10 patients (12-16 years old), and their parents, receiving orthodontic care to investigate treatment decision making and inform the content of the FADA and (b) 23 stakeholders critiquing the draft decision aid's content, structure and utility...
October 17, 2016: Journal of Orthodontics
Magenta B Simmons, Aurora Elmes, Joanne E McKenzie, Lyndal Trevena, Sarah E Hetrick
BACKGROUND: Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this. OBJECTIVES: The main objective of this study was to evaluate an online decision aid for youth depression. DESIGN: An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements. SETTING AND PARTICIPANTS: Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services...
October 17, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Lauren J Ralph, Diana Greene Foster, Katrina Kimport, David Turok, Sarah C M Roberts
OBJECTIVE: Evaluating decisional certainty is an important component of medical care, including preabortion care. However, minimal research has examined how to measure certainty with reliability and validity among women seeking abortion. We examine whether the Decisional Conflict Scale (DCS), a measure widely used in other health specialties and considered the gold standard for measuring this construct, and the Taft-Baker Scale (TBS), a measure developed by abortion counselors, are valid and reliable for use with women seeking abortion and predict the decision to continue the pregnancy...
October 10, 2016: Contraception
Rachel V van Schendel, Lieve Page-Christiaens, Lean Beulen, Catia M Bilardo, Marjon A de Boer, Audrey B C Coumans, Brigitte H Faas, Irene M van Langen, Klaske D Lichtenbelt, Merel C van Maarle, Merryn V E Macville, Dick Oepkes, Eva Pajkrt, Lidewij Henneman
OBJECTIVE: To evaluate preferences and decision-making amongst high-risk pregnant women offered a choice between Non-Invasive Prenatal Testing (NIPT), invasive testing or no further testing. METHODS: Nationwide implementation study (TRIDENT) offering NIPT as contingent screening test for women at increased risk for fetal aneuploidy based on first-trimester combined testing (>1:200) or medical history. A questionnaire was completed after counseling assessing knowledge, attitudes and participation following the Multidimensional Measure of Informed Choice...
October 14, 2016: Prenatal Diagnosis
Mehmet I Gökce, Xuemei Wang, Jacqueline Frost, Pamela Roberson, Robert J Volk, Durado Brooks, Steven E Canfield, Curtis A Pettaway
BACKGROUND: The American Cancer Society (ACS) recommends men have the opportunity to make an informed decision about screening for prostate cancer (PCa). The ACS developed a unique decision aid (ACS-DA) for this purpose. However, to date, studies evaluating the efficacy of the ACS-DA are lacking. The authors evaluated the ACS-DA among a cohort of medically underserved men (MUM). METHODS: A multiethnic cohort of MUM (n = 285) was prospectively included between June 2010 and December 2014...
October 11, 2016: Cancer
Jennifer B Manders, Henry M Kuerer, Benjamin D Smith, Cornelia McCluskey, William B Farrar, Thomas G Frazier, Linna Li, Charles E Leonard, Dennis L Carter, Sheema Chawla, Lori E Medeiros, J Michael Guenther, Lauren E Castellini, Daniel J Buchholz, Eleftherios P Mamounas, Irene L Wapnir, Kathleen C Horst, Anees Chagpar, Suzanne B Evans, Adam I Riker, Faisal S Vali, Lawrence J Solin, Lisa Jablon, Abram Recht, Ranjna Sharma, Ruixiao Lu, Amy P Sing, E Shelley Hwang, Julia White
OBJECTIVE: The aim of this study was to determine the impact of the results of the 12-gene DCIS Score assay on (i) radiotherapy recommendations for patients with pure ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), and (ii) patient decisional conflict and state anxiety. METHODS: Thirteen sites across the US enrolled patients (March 2014-August 2015) with pure DCIS undergoing BCS. Prospectively collected data included clinicopathologic factors, physician estimates of local recurrence risk, DCIS Score results, and pre-/post-assay radiotherapy recommendations for each patient made by a surgeon and a radiation oncologist...
October 4, 2016: Annals of Surgical Oncology
Shiu-Yu C Katie Lee
The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options...
October 2016: Hu Li za Zhi the Journal of Nursing
Ann C Long, Erin K Kross, J Randall Curtis
PURPOSE OF REVIEW: Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. RECENT FINDINGS: Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life...
September 28, 2016: Current Opinion in Critical Care
Joe Hulin, Sarah R Baker, Zoe Marshman, Sondos Albadri, Helen D Rodd
BACKGROUND: Decision aids are tools used to help individuals faced with difficult healthcare decisions. They help patients further understand the treatment options available and encourage the sharing of information between patients and clinicians. AIM: To develop a decision aid for young patients faced with the decision to undergo dental treatment with inhalation sedation, intravenous sedation, or general anaesthesia (GA). DESIGN: Qualitative interviews with dental patients (aged 10-16 years), and their parents/guardians were used to inform the content of a draft decision aid...
September 29, 2016: International Journal of Paediatric Dentistry
Veronica F Quinn, Bettina Meiser, Judy Kirk, Kathy M Tucker, Kaaren J Watts, Belinda Rahman, Michelle Peate, Christobel Saunders, Elizabeth Geelhoed, Margaret Gleeson, Kristine Barlow-Stewart, Michael Field, Marion Harris, Yoland C Antill, Linda Cicciarelli, Karen Crowe, Michael T Bowen, Gillian Mitchell
PURPOSE: Increasingly, women newly diagnosed with breast cancer are being offered treatment-focused genetic testing (TFGT). As the demand for TFGT increases, streamlined methods of genetic education are needed. METHODS: In this noninferiority trial, women aged <50 years with either a strong family history (FH+) or other features suggestive of a germ-line mutation (FH-) were randomized before definitive breast cancer surgery to receive TFGT education either as brief written materials (intervention group (IG)) or during a genetic counseling session at a familial cancer clinic (usual-care group (UCG))...
September 29, 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Sarah L Rowe, Rebecca S French, Claire Henderson, Dennis Ougrin, Mike Slade, Paul Moran
INTRODUCTION: Self-harm is common in adolescents, and it is the strongest predictor of suicide. Young people who self-harm are often unsure of how and where to get help. Decision aids (DAs) have been shown to help with decisional conflict where there is uncertainty around different options. We have developed an online DA to support young people in help-seeking for self-harm. A feasibility trial will examine the acceptability of the online intervention and the ability to recruit and follow-up participants within a school setting...
2016: BMJ Open
Kerry A Sherman, Laura-Kate E Shaw, Caleb J Winch, Diana Harcourt, John Boyages, Linda D Cameron, Paul Brown, Thomas Lam, Elisabeth Elder, James French, Andrew Spillane
BACKGROUND: Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. METHODS: Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire...
October 2016: Plastic and Reconstructive Surgery
Celia Hoi Yan Chan, Hi Po Bobo Lau, Michelle Yi Jun Tam, Ernest Hung Yu Ng
STUDY QUESTION: What is the relationship between decisional conflict, decisional regret and psychological well-being in women following unsuccessful IVF cycles? SUMMARY ANSWER: The mediating effect of decisional regret on the relationship between decisional conflict and fertility-related quality of life (FRQOL) has been found to be moderated by the availability (versus absence) of frozen embryos after an unsuccessful IVF cycle. WHAT IS KNOWN ALREADY: Infertility treatment is marked by its open-ended nature...
September 22, 2016: Human Reproduction
A J Smallwood, M M Schapira, M Fedders, J M Neuner
: We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care. INTRODUCTION: Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited...
September 19, 2016: Osteoporosis International
Lindsay A Hampson, Isabel E Allen, Thomas W Gaither, Tracy Lin, Jie Ting, E Charles Osterberg, Leslie Wilson, Benjamin N Breyer
OBJECTIVE: To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients' decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains. METHODS: The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects...
September 16, 2016: Urology
Anne R Links, David E Tunkel, Emily F Boss
Importance: Parental decision making about adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is associated with decisional conflict that may be alleviated with improved knowledge about symptoms and treatments. Objective: To develop a measure of parental knowledge about oSDB and AT. Design, Setting, and Participants: A sequential design was used for scale development. A prototype measure containing 9 oSDB and AT themes and 85 items was administered in survey format via an online platform...
September 15, 2016: JAMA Otolaryngology—Head & Neck Surgery
Susan W Krigel, James E Grobe, Kathy Goggin, Kari Jo Harris, Jose L Moreno, Delwyn Catley
INTRODUCTION: The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS: College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE)...
August 31, 2016: Addictive Behaviors
Lindsay A Renfro, Nan Zhang, Margarita Lopatin, Calvin Chao, Steven R Alberts
BACKGROUND: The Oncotype DX colon cancer assay is a validated predictor of recurrence risk in patients with resected stage II colon cancer. We previously reported that Oncotype DX led to a change in treatment recommendations for 45% of patients with T3 mismatch repair proficient (MMR-P) stage II tumors in a prospective study. In the present study, we report the assay's influence on patient treatment decisions, physician confidence, concordance between physicians and patients, and patient decisional conflict...
August 9, 2016: Clinical Colorectal Cancer
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