Med Decis Making - Interpreting patient decisional conflict scores: behavior and emotions in decisions about treatment.

Tópicos

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Resumo

CKGROUND: Patient decision aids facilitate treatment decisions. They are often evaluated in terms of their effect on decisional conflict, as measured by the Decisional Conflict Scale (DCS). It is unclear to what extent lower DCS scores are accompanied by observable patient behavior or emotions.OBJECTIVE: To help interpret DCS scores.DESIGN: In a Dutch university hospital, statements on behaviors or emotions during decision making were collected from asymptomatic aneurysm patients and healthy employees. Subsequently, they rated the intensity of decisional conflict that each statement expresses on a 1 to 10 scale. Selected statements were prospectively tested in aneurysm patients and cancer patients facing treatment dilemmas.MEASUREMENTS: Associations between patients' DCS scores and reported behavior and emotions were analyzed using logistic regression analysis.RESULTS: Participants provided 363 statements on behaviors and emotions during decision making, of which 28 were mentioned more than 4 times. Nine forms of behavior and emotions were selected as they were graded with the least variable median ratings of intensity of decisional conflict. Among 100 patients facing a treatment dilemma, each point increase in DCS lowered their odds for "immediately making the decision" (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93-0.98), whereas the odds of "fretting regularly" (OR, 1.05; 95% CI, 1.02-1.08) and "feeling nervous when thinking of the decision" (OR, 1.04; 95% CI, 1.01-1.06) where higher.CONCLUSIONS: A decrease in decisional conflict scores leads to less decision postponing behavior, fretting, and nervousness. Research should focus on which DCS scores are needed to make deliberate decisions and which scores hinder patients in decision making.

Resumo Limpo

ckground patient decis aid facilit treatment decis often evalu term effect decision conflict measur decision conflict scale dcs unclear extent lower dcs score accompani observ patient behavior emotionsobject help interpret dcs scoresdesign dutch univers hospit statement behavior emot decis make collect asymptomat aneurysm patient healthi employe subsequ rate intens decision conflict statement express scale select statement prospect test aneurysm patient cancer patient face treatment dilemmasmeasur associ patient dcs score report behavior emot analyz use logist regress analysisresult particip provid statement behavior emot decis make mention time nine form behavior emot select grade least variabl median rate intens decision conflict among patient face treatment dilemma point increas dcs lower odd immedi make decis odd ratio confid interv ci wherea odd fret regular ci feel nervous think decis ci higherconclus decreas decision conflict score lead less decis postpon behavior fret nervous research focus dcs score need make deliber decis score hinder patient decis make

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