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Decisional conflict

Wenjie Zhong, Kayvan Haghighi, Prem Rathore, Eddy Wong, Pascal Mancuso
Robot-assisted radical prostatectomy to treat localized prostate cancer has increased in popularity, although other options exist, including radiotherapy and active surveillance. The decision about choosing the right treatment has become pertinent for many patients. This literature review aimed to assess the current state-of-the-art regarding decisional aids and the associated decisional outcomes for the purpose of designing a method for both patients and doctors to use to make the best treatment decision for the patient...
March 16, 2018: Journal of Robotic Surgery
Julia S Anixt, Jareen Meinzen-Derr, Halley Estridge, Laura Smith, William B Brinkman
OBJECTIVE: To describe the characteristics of treatment decisions to address challenging behaviors in children with autism spectrum disorder (ASD). METHODS: Parents of children aged 4 to 15 years with ASD seen in a developmental behavioral pediatric (DBP) clinic completed validated measures to characterize their child's behaviors and their own level of stress. Parents reported their treatment priority before the visit. During the visit, we assessed shared decision making (SDM) using the Observing Patient Involvement (OPTION) scale and alignment of the clinician's treatment plan with the parent's priority...
March 12, 2018: Journal of Developmental and Behavioral Pediatrics: JDBP
Sarah K Mesrobian, Alessandro E P Villa, Michel Bader, Lorenz Götte, Alessandra Lintas
Attention-deficit hyperactivity disorder (ADHD) is characterized by deficits in executive functions and decision making during childhood and adolescence. Contradictory results exist whether altered event-related potentials (ERPs) in adults are associated with the tendency of ADHD patients toward risky behavior. Clinically diagnosed ADHD patients ( n = 18) and healthy controls ( n = 18), aged between 18 and 29 (median 22 Yo), were screened with the Conners' Adult ADHD Rating Scales and assessed by the Mini-International Neuropsychiatric Interview, adult ADHD Self-Report Scale, and by the 60-item HEXACO Personality Inventory...
2018: Frontiers in Human Neuroscience
Katie L Lewis, Kendall L Umstead, Jennifer J Johnston, Ilana M Miller, Lydia J Thompson, Kristen P Fishler, Leslie G Biesecker, Barbara B Biesecker
In-person education and counseling for all people receiving genetic results is the predominant model of disclosure but is challenged by the growing volume of low-impact results generated by sequencing. Evidence suggests that web-based tools may be as effective as in-person counseling at educating individuals about their low-impact results. However, the effects of counseling have not been assessed. To evaluate its utility, carrier results were returned to 459 post-reproductive participants from the ClinSeq cohort within a randomized controlled trial...
March 7, 2018: American Journal of Human Genetics
Nicole R Fowler, C Elizabeth Shaaban, Alexia M Torke, Kathleen A Lane, Samir Saba, Amber E Barnato
Background: The decision to implant a cardiac device in a person with Alzheimer's disease or related dementia requires considering the possible trade-offs of quality of life (QOL) and quantity of life. This study measured the decision-making experience of patients with and without cognitive impairment (CI) who received a cardiac device and their family members who were involved in the decision. Methods and Results: Semi-structured interviews and questionnaires were administered with 15 patient-family member dyads...
2018: Cardiol Cardiovasc Med
David D Stenehjem, Trang Au, Amy M Sainski, Hillevi Bauer, Krystal Brown, Johnathan Lancaster, Vanessa Stevens, Diana I Brixner
BACKGROUND: Genetic counseling by a Genetic Counselor (GC) is a requirement prior to genetic testing for cancer susceptibility genes (GC-mandate policy) for some insurers. This study evaluated the impact of this policy from the patient perspective. METHODS: Surveys were sent to individuals for whom their insurer ordered genetic testing for the cancer susceptibility genes BCRA1 and BRCA2 over a 1 year time period that spanned the introduction of a GC-mandate policy...
March 7, 2018: BMC Health Services Research
Marie-Anne van Stam, Arwen H Pieterse, Henk G van der Poel, J L H Ruud Bosch, Corinne Tillier, Simon Horenblas, Neil K Aaronson
PURPOSE: The aims of this study were: (1) to describe preferred and experienced roles in treatment decision-making among patients with localized prostate cancer (PC); (2) to identify how often patients' experienced roles matched their preferred roles; and (3) to determine whether active involvement in decision-making regardless of role preferences, or concordance between preferred and experienced role is the strongest predictor of more favourable patient-reported outcomes. MATERIAL AND METHODS: In this prospective, multicenter, observational study we obtained serial questionnaire data from newly-diagnosed localized PC patients (cT1-cT2 or Gleason≤7, PSA≤20) (N=454)...
February 28, 2018: Journal of Urology
Anna Roberto, Cinzia Colombo, Giulia Candiani, Livia Giordano, Paola Mantellini, Eugenio Paci, Roberto Satolli, Mario Valenza, Paola Mosconi
In Italy women aged 50-69 are invited for a population-based breast cancer (BC) screening. Physicians, policy makers and patient associations agree on the need to inform women about the benefits and harms in order to permit an informed decision. Decision aids (DA) are an effective way to support people in their decisions about health. This trial aims to assess women's informed choices, according to their health literacy and values, on participating or not in BC screening for the first time. Benefits, harms and controversies are presented...
February 2018: Recenti Progressi in Medicina
Shin Hye Yoo, Young Ho Yun, Kyoung-Nam Kim, Jung Lim Lee, Jeanno Park, Youn Seon Choi, Yeun Keun Lim, Samyong Kim, Hyun Sik Jeong, Jung Hun Kang, Ho-Suk Oh, Ji Chan Park, Si-Young Kim, Hong Suk Song, Keun Seok Lee, Dae Seog Heo, Young Seon Hong
PURPOSE: The objective of this study was to investigate the impact of caregivers' role preference in decision making on conflicts and psychiatric distresses. METHODS: The responses of 406 caregivers of terminal cancer patients enrolled in a trial determining the efficacy of a decision aid focused on the disclosure of terminal disease status were included in this secondary analysis. The outcomes include the change scores of the Decision Conflict Scale (DCS) and depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS) at the 1 and 3 months from baseline...
February 24, 2018: Quality of Life Research
Terri Lynn Woodard, Aubri S Hoffman, Laura C Crocker, Deborah A Holman, Derek B Hoffman, Jusheng Ma, Roland L Bassett, Viola B Leal, Robert J Volk
INTRODUCTION: National guidelines recommend that all reproductive-age women with cancer be informed of their fertility risks and offered referral to fertility specialists to discuss fertility preservation options. However, reports indicate that only 5% of patients have consultations, and rates of long-term infertility-related distress remain high. Previous studies report several barriers to fertility preservation; however, initial success has been reported using provider education, patient decision aids and navigation support...
February 21, 2018: BMJ Open
Erin Turbitt, Paola P Chrysostomou, Holly L Peay, Alexis R Heidlebaugh, Lawrence M Nelson, Barbara B Biesecker
To make an informed choice to participate in a genome sequencing study that may yield primary and secondary findings, one understands relevant information in the context of personal values. Consent forms to enroll in a sequencing study can be long and complex. The efficacy of the professional encounter to consider the information contained in the consent form and make an informed choice is unknown. Women diagnosed with primary ovarian insufficiency and eligible for a sequencing study were randomized to participate in one of two encounters with a genetic counselor: a consent intervention using a lower literacy, less dense form or a standard consent encounter...
February 16, 2018: European Journal of Human Genetics: EJHG
Lesley Fallowfield, Lucy Matthews, Shirley May, Valerie Jenkins, David Bloomfield
Chemotherapy side-effects can be substantial. There is increasing recognition that some oestrogen receptor positive (ER+ve), human epidermal growth factor receptor 2 negative (HER2-ve) patients with breast cancer derive no benefit from chemotherapy and experience only iatrogenic harm. Gene expression profiling tests help refine recurrence risk and likely chemotherapy benefit. EndoPredict® is one such test, which classifies risks of distant recurrence as low or high in patients treated with surgery and adjuvant endocrine therapy alone...
February 15, 2018: Psycho-oncology
Masoumeh Kordi, Sahar Riyazi, Marziyeh Lotfalizade, Mohammad Taghi Shakeri, Hoseyn Jafari Suny
BACKGROUND AND GOAL: Screening of fetal anomalies is assumed as a necessary measurement in antenatal cares. The screening plans aim at empowerment of individuals to make the informed choice. This study was conducted in order to compare the effect of group and face-to-face education and decisional conflicts among the pregnant females regarding screening of fetal abnormalities. METHODS: This study of the clinical trial was carried out on 240 pregnant women at <10-week pregnancy age in health care medical centers in Mashhad city in 2014...
2018: Journal of Education and Health Promotion
Laura Siga Stephan, Eduardo Dytz Almeida, Raphael Boesche Guimarães, Antonio Gaudie Ley, Rodrigo Gonçalves Mathias, Maria Valéria Assis, Tiago Luiz Luz Leiria
BACKGROUND: Atrial fibrillation is responsible for one in four strokes, which may be prevented by oral anticoagulation, an underused therapy around the world. Considering the challenges imposed by this sort of treatment, mobile health support for shared decision-making may improve patients' knowledge and optimize the decisional process. OBJECTIVE: To develop and evaluate a mobile application to support shared decision about thromboembolic prophylaxis in atrial fibrillation...
February 1, 2018: Arquivos Brasileiros de Cardiologia
Allison K Ikeda, Paul Hong, Stacey L Ishman, Stephanie A Joe, Gregory W Randolph, Jennifer J Shin
Shared decision making (SDM) is a collaborative process in which patients, families, and clinicians develop a mutually agreed upon treatment plan when more than one reasonable treatment option exists. This cooperative engagement fosters improvements in patient satisfaction, disease management, and outcomes and also has the capacity to promote evidence-based care. Thus, this seventh installment of our Evidence-Based Medicine in Otolaryngology series focuses on SDM. We introduce SDM, including its potential to reduce decisional conflict and decisional regret, when it should be used, its potential benefits, barriers to implementation, and its role in the management of chronic disease and otolaryngological conditions...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Catherine Benedict, Bridgette Thom, Danielle N Friedman, Elaine Pottenger, Nirupa Raghunathan, Joanne F Kelvin
BACKGROUND: Cancer treatment may lead to premature menopause and infertility. Young adult female cancer survivors (YAFCS) are often concerned about their fertility and future family-building options, but research is limited on how concerns may affect more general quality of life (QOL) domains. This study examined how fertility factors relate to QOL among YAFCS who received gonadotoxic therapy. METHOD: A national sample of YAFCS completed an online, anonymous survey...
February 1, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Michael D Linderman, Saskia C Sanderson, Ali Bashir, George A Diaz, Andrew Kasarskis, Randi Zinberg, Milind Mahajan, Sabrina A Suckiel, Micol Zweig, Eric E Schadt
BACKGROUND: To address the need for more effective genomics training, beginning in 2012 the Icahn School of Medicine at Mount Sinai has offered a unique laboratory-style graduate genomics course, "Practical Analysis of Your Personal Genome" (PAPG), in which students optionally sequence and analyze their own whole genome. We hypothesized that incorporating personal genome sequencing (PGS) into the course pedagogy could improve educational outcomes by increasing student motivation and engagement...
January 30, 2018: BMC Medical Genomics
Susan H Davide, Anthony J Santella, Winnie Furnari, Petal Leuwaisee, Marilyn Cortell, Bhuma Krishnamachari
Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics.Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months...
December 2017: Journal of Dental Hygiene: JDH
Laura Boland, Monica Taljaard, Geoffrey Dervin, Logan Trenaman, Peter Tugwell, Marie-Pascale Pomey, Dawn Stacey
BACKGROUND: Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. METHODS: We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education...
February 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Sophie Bouton, Valérian Chambon, Rémi Tyrand, Adrian G Guggisberg, Margitta Seeck, Sami Karkar, Dimitri van de Ville, Anne-Lise Giraud
Percepts and words can be decoded from distributed neural activity measures. However, the existence of widespread representations might conflict with the more classical notions of hierarchical processing and efficient coding, which are especially relevant in speech processing. Using fMRI and magnetoencephalography during syllable identification, we show that sensory and decisional activity colocalize to a restricted part of the posterior superior temporal gyrus (pSTG). Next, using intracortical recordings, we demonstrate that early and focal neural activity in this region distinguishes correct from incorrect decisions and can be machine-decoded to classify syllables...
January 23, 2018: Proceedings of the National Academy of Sciences of the United States of America
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