1,293 results match your criteria decisional conflict


Low conflict and high satisfaction: Decisional outcomes after attending a combined clinic to choose between robotic prostatectomy and radiotherapy for prostate cancer.

Urol Oncol 2021 Jun 8. Epub 2021 Jun 8.

Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW.

Background: Decisional conflict and post-treatment decisional regret have been documented in men with localised prostate cancer (LPC). However, there is limited evidence regarding decisional outcomes associated with the choice between robotic-assisted radical prostatectomy (RARP) and radiotherapy, when both treatment options are available in the public health system. There is increasing support for multidisciplinary approaches to guide men with LPC in their decision-making process. Read More

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Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study.

JMIR Res Protoc 2021 Jun 11;10(6):e26264. Epub 2021 Jun 11.

Department of Clinical Research, University of Basel, Basel, Switzerland.

Background: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Read More

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Couple-based expanded carrier screening provided by general practitioners to couples in the Dutch general population: psychological outcomes and reproductive intentions.

Genet Med 2021 Jun 10. Epub 2021 Jun 10.

Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Purpose: The aim of expanded preconception carrier screening (ECS) is to inform any couple wishing to conceive about their chances of having children with severe autosomal or X-linked recessive conditions. Responsible implementation of ECS as reproductive genetic screening in routine care requires assessment of benefits and harms. We examined the psychological outcomes of couple-based ECS for 50 autosomal recessive (AR) conditions provided by general practitioners (GPs) to couples from the Dutch general population. Read More

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Exploring the STEP-uP to practice: A survey of UK Lead Midwives for Education views of the STudent midwife Extended Practice Placement during the first wave of the COVID-19 pandemic.

Midwifery 2021 May 28;101:103048. Epub 2021 May 28.

Division of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom. Electronic address:

Objective: to assess the effect of implementation of the extended placement option available to midwifery students during the first wave of the COVID-19 pandemic.

Design: Online survey open from 2nd June 2020 to 15th July 2020.

Setting: United Kingdom. Read More

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Personalized, Electronic Health Record-Integrated Decision Aid for Stroke Prevention in Atrial Fibrillation: A Small Cluster Randomized Trial and Qualitative Analysis of Efficacy and Acceptability.

Circ Cardiovasc Qual Outcomes 2021 Jun 10:CIRCOUTCOMES120007329. Epub 2021 Jun 10.

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (J.B., C.L.P., C.H.S., M.C.).

Background: Shared decision-making in cardiology is increasingly recommended to improve patient-centeredness of care. Decision aids can improve patient knowledge and decisional quality but are infrequently used in real-world practice. This mixed-methods study tests the efficacy and acceptability of a decision aid integrated into the electronic health record (Integrated Decision Aid [IDeA]) and delivered by clinicians for patients with atrial fibrillation considering options to reduce stroke risk. Read More

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Locoregional Flap Reconstruction Following Oromaxillofacial Oncologic Surgery in Dogs and Cats: A Review and Decisional Algorithm.

Front Vet Sci 2021 21;8:685036. Epub 2021 May 21.

Dentistry and Oromaxillofacial Surgery Unit, Department of Surgery, ADVETIA Centre Hospitalier Vétérinaire, Vélizy-Villacoublay, France.

Primary treatment of most oromaxillofacial tumors in dogs and cats is resective surgery. Management of malignant tumors may be very challenging as wide/radical free-margin surgical removal must be achieved while preserving vital functions. Removal of orofacial tumors may result in large defects exposing the oral cavity or creating a communication with the nasal, pharyngeal, or orbital cavities. Read More

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A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making.

Vaccine 2021 May 26. Epub 2021 May 26.

National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Locked Bag 4001, 2145 Westmead, NSW, Australia; University of Sydney, Susan Wakil School of Nursing and Midwifery, Camperdown, NSW 2006, Australia. Electronic address:

Background: This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes, decisional conflict, intent to vaccinate and timeliness.

Methods: Searches were conducted in OVID Medline, OVID Embase, CINAHL, PsycINFO, the Cochrane Library and SCOPUS. Randomised controlled trials were included if they evaluated the impact of decision aids as defined by the International Patient Decision Aids Standards Collaboration. Read More

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Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

Ann Otol Rhinol Laryngol 2021 May 27:34894211018914. Epub 2021 May 27.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.

Objective: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients.

Methods: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21).

Results: The cohort included 118 patients, 61 (51. Read More

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Theory-based approach to developing an implementation plan to support the adoption of a patient decision aid for Down syndrome prenatal screening.

Implement Sci 2021 May 25;16(1):56. Epub 2021 May 25.

Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada.

Background: Our team has developed a decision aid to help pregnant women and their partners make informed decisions about Down syndrome prenatal screening. However, the decision aid is not yet widely available in Quebec's prenatal care pathways.

Objective: We sought to identify knowledge translation strategies and develop an implementation plan to promote the use of the decision aid in prenatal care services in Quebec, Canada. Read More

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A qualitative meta-synthesis of evidence (meta-ethnography) exploring the personal experiences of gastrostomy tube in neurodegenerative diseases: a case of motor neurone disease.

Disabil Rehabil 2021 May 25:1-17. Epub 2021 May 25.

North Yorkshire Disability Forum, Whitby, UK.

Purpose: The lived experiences of a gastrostomy tube (GT) in adults with neurodegenerative diseases (NDDs) are not well understood. The aim of this qualitative meta-synthesis was to review and synthesise the available evidence to inform clinical practice and identify research gaps.

Methods: Meta-ethnographic synthesis of qualitative studies was conducted with systematic searching of eight databases from inception to March 2021. Read More

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Assessing patient information and decision-support needs in problematic alcohol use and co-occurring depression to inform shared decision-making interventions.

Bull Menninger Clin 2021 ;85(2):143-176

Matilda Centre for Research in Mental Health and Substance Use, Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia.

The authors assessed the informational and decision-support needs of patients, families, and clinicians when deciding on treatment for problematic alcohol use and depression. Patients (n = 56), family members (n = 16), and clinicians (n = 65) with experience deciding on treatment for problematic alcohol use and depression were eligible. Participants completed an online decisional needs assessment survey. Read More

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January 2021

Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards.

Med Decis Making 2021 May 22:272989X211011100. Epub 2021 May 22.

Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.

Background: This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand.

Method: To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. Read More

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When two is worse than one: The deleterious impact of multisensory stimulation on response inhibition.

PLoS One 2021 20;16(5):e0251739. Epub 2021 May 20.

Brain & Cognition Research Center (CerCo), University of Toulouse 3 -CNRS, Toulouse, France.

Multisensory facilitation is known to improve the perceptual performances and reaction times of participants in a wide range of tasks, from detection and discrimination to memorization. We asked whether a multimodal signal can similarly improve action inhibition using the stop-signal paradigm. Indeed, consistent with a crossmodal redundant signal effect that relies on multisensory neuronal integration, the threshold for initiating behavioral responses is known for being reached faster with multisensory stimuli. Read More

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'When the picture does not really tell the story'- A qualitative exploration of the MRI report of findings as a means for generating shared diagnostic meaning during the management of patients suffering from persistent spinal pain.

Patient Educ Couns 2021 May 5. Epub 2021 May 5.

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark; Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, DK 5230 Odense M, Denmark.

Objectives: To explore the magnetic resonance imaging (MRI) feedback report as a health care encounter for generating shared diagnostic meaning.

Methods: An exploratory, qualitative case study was conducted using video observation of the MRI report of findings, individual face-to-face and telephonic interviews.

Results: From fourteen distinct encounters, three key themes emerged, these being: 'a powerful shared experience, 'a legacy of biomedical thinking' and 'clinical practice quandaries'. Read More

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Development and Evaluation of a Prediabetes Decision Aid in Primary Care: Examining Patient-Reported Outcomes by Language Preference and Educational Attainment.

Sci Diabetes Self Manag Care 2021 Jun;47(3):216-227

Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Purpose: The purpose of this study was to examine the development and preliminary effectiveness of a novel Prediabetes Decision Aid on adoption of intensive lifestyle interventions (ILIs) and metformin. Little research has focused on increasing uptake of these evidence-based treatments, especially among non-English speakers and those with low educational attainment.

Methods: Investigators developed an English and Spanish decision aid displaying information about type 2 diabetes (T2DM) risk and treatments to prevent T2DM and prompting patients to identify next steps for management. Read More

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Effect of a discordant opinion offered by a second opinion physician on the patient's decision for management of spinal disc disease.

Patient Educ Couns 2021 May 4. Epub 2021 May 4.

Department of Family Medicine, American University of Beirut, Lebanon. Electronic address:

Background: Factors that influence a patient's decision for spinal surgery and selection of the spine surgeon have not been studied in the context of a Second Opinion (SO). Providing insight into these factors will guide surgeons in their discussion of treatment options with patients.

Objective: This study aims to assess the impact of a discordant SO on the final decision of patients as compared to their initial preference regarding spinal disc disease treatment for chronic neck and low back pain. Read More

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Evaluation of a smoking cessation patient decision aid that integrates information about e-cigarettes.

Nicotine Tob Res 2021 May 13. Epub 2021 May 13.

Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond.

Introduction: Smokers increasingly use e-cigarettes to try to quit smoking, even more than recommended cessation methods. However, few smokers discuss the range of cessation options with their physicians. Decision aids can inform smokers about smoking cessation options, including evidence about e-cigarettes, and encourage smokers to engage in shared decision making with their physician. Read More

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Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review.

Eur Urol Focus 2021 May 9. Epub 2021 May 9.

Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany.

Context: Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs.

Objective: To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities. Read More

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Identifying patient values impacting the decision whether to participate in early phase clinical cancer trials: A systematic review.

Cancer Treat Rev 2021 Apr 28;98:102217. Epub 2021 Apr 28.

Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

Background: For many patients with advanced cancer, the decision whether to participate in early phase clinical trials or not is complex. The decision-making process requires an in-depth discussion of patient values. We therefore aimed to synthesize and describe patient values that may affect early phase clinical trial participation. Read More

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The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers.

Inj Epidemiol 2021 May 3;8(1):23. Epub 2021 May 3.

School of Public Health, University of California San Diego, San Diego, CA, USA.

Background: Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult's health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. Read More

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Decision aid for women with newly diagnosed breast cancer seeking breast reconstruction surgery: A prospective, randomized, controlled, single-blinded, pilot study.

J Plast Reconstr Aesthet Surg 2021 Mar 28. Epub 2021 Mar 28.

Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address:

Background: Women undergoing immediate breast reconstruction for breast cancer often experience anxiety when faced with reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction.

Methods: Newly diagnosed breast cancer patients seeking breast reconstruction at a single center were prospectively randomized into two groups. Read More

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Restricted mean survival time versus conventional measures for treatment decision-making.

J Am Geriatr Soc 2021 Apr 26. Epub 2021 Apr 26.

Department of Biostatistics, Harvard University, Boston, Massachusetts, USA.

Background/objectives: Restricted mean survival time (RMST) summarizes treatment effect in terms of a gain or loss in the event-free days. It remains uncertain whether communicating treatment benefit and harm using RMST-based summary is more effective than conventional summary based on absolute and relative risk reduction. We compared the effect of RMST-based approach and conventional approach on decisional conflict using an example of intensive versus standard blood pressure-lowering strategies. Read More

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Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan.

Med Decis Making 2021 Jul 24;41(5):540-549. Epub 2021 Apr 24.

Knowledge and Evaluation Research (KER) Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Objective: Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact.

Methods: We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Read More

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A Randomized Controlled Trial on the Effect of Standardized Video Education on Prenatal Genetic Testing Choices: Uptake of Genetic Testing.

Am J Perinatol 2021 Apr 20. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California.

Objective:  This study aimed to assess the use of a standardized prenatal genetic testing educational video and its effects on patient uptake of prenatal testing, patient knowledge, decisional conflict, and decisional regret.

Study Design:  This was an IRB-approved randomized controlled trial. Patients were randomized to intervention (standardized video education) or control (no video education). Read More

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Web-based decision aids for cancer clinical decisions: a systematic review and meta-analysis.

Support Care Cancer 2021 Apr 8. Epub 2021 Apr 8.

The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, People's Republic of China.

Objective: The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types.

Methods: Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e. Read More

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DUCHESS: an evaluation of the ductal carcinoma in situ score for decisions on radiotherapy in patients with low/intermediate-risk DCIS.

Breast Cancer Res Treat 2021 Apr 8. Epub 2021 Apr 8.

Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, Canada.

Background: Identification of women with DCIS who have a very low risk of local recurrence risk (LRR) after breast-conserving surgery (BCS) is needed to de-escalate therapy. We evaluated the impact of 10-year LRR estimates after BCS, calculated by the integration of a 12-gene molecular expression assay (Oncotype Breast DCIS Score) and clinicopathological features (CPFs), on its ability to change radiation oncologists' recommendations for RT after BCS for DCIS.

Methods: Prospective cohort study of women with DCIS treated with BCS. Read More

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Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey.

Interact Cardiovasc Thorac Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.

Objectives: Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR).

Methods: We surveyed 113 patients who were operated on for AVR at 60-70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Read More

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Chronically ill children's participation and health outcomes in shared decision-making: a scoping review.

Eur J Pediatr 2021 Apr 5. Epub 2021 Apr 5.

Department of Surgery, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands.

Based on the United Nations Conventions on the Rights of the Child (CRC), it is a child's right to participate in all matters concerning its wellbeing. Little is known about chronically and/or critically ill children's participation in pediatric shared decision-making (SDM). We explored medical literature to see if and how these children participate in pediatric SDM. Read More

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Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies.

Int J Environ Res Public Health 2021 03 5;18(5). Epub 2021 Mar 5.

Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK.

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients' self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients' T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. Read More

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Better safe than wealthy: Dysfunctional risk avoidance in spider-fearful individuals.

J Anxiety Disord 2021 04 9;79:102383. Epub 2021 Mar 9.

Department of Psychology, School of Social Sciences, University of Mannheim, Germany. Electronic address:

Previous research has documented that fearful individuals avoid fear-relevant cues even if they incur costs in doing so. Paradigms that were previously used to study avoidance in the lab, manipulated reward contingencies in favor of selecting either fear-relevant or neutral cues, e.g. Read More

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