Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment

Abstract

BackgroundBreast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions.Methods320 women aged 20–79 diagnosed with AJCC stage 0 – III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach’s alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation.ResultsFor overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of “Right for You” for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively.ConclusionsOur measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of information, time, and involvement. Future research is needed to establish norms for the measure as is further psychometric testing, particularly to examine how it is associated with outcomes such as quality of life, psychological coping and objective decision quality.

Understanding the engagement of key decision support persons in patient decision making around breast cancer treatment

“…Our findings suggest that having an informed DSP may be one way to achieve better SDQ. This may be because being informed is a key component of SDQ, and the informed DSP contributes to that component . Although feeling informed is not the same as possessing objective knowledge, our measure of DSPs’ objective knowledge was not associated with SDQ.…”

“…We acknowledge that a more deliberative decision is not necessarily a “good” one; patients and DSPs may spend a lot of time thinking through a decision and ultimately choose a treatment against the recommendation of their health care provider . Yet, studies suggest that the process of decision making is an important outcome in itself, and feeling rushed may cause dissatisfaction with this process . Further work to assess the clinical outcomes of these decisions is needed.…”

“…We assessed 2 related but distinct domains of patients’ appraisal of their own decision making: 1) subjective decision quality (SDQ) and 2) deliberation (or the extent of “thinking through” the treatment options). As previously reported, SDQ was measured with a 5‐item scale assessing the degree to which patients felt informed, involved, satisfied, and not regretful with respect to the locoregional treatment decision–making process. Deliberation was measured with a 4‐item scale developed from a public deliberation scale assessing the degree to which patients thought through their treatment‐related decisions.…”

Does physician communication style impact patient report of decision quality for breast cancer treatment?

“…The psychometric properties of the scale and complete scoring information have been reported in detail previously [34]. For this sample, Cronbach’s alpha was 0.77 for surgical decisions and 0.86 for chemotherapy decisions.…”

“…Decision quality, our primary dependent variable, was measured via a five-item instrument we recently developed called the Brief Subjective Decision Quality Measure [34]. This patient-reported measure covers five domains of decision making: (1) decision regret and (2) satisfaction, (3) perceived adequacy of information to make the decision, (4) sufficient time to make the decision, and (5) level of decisional involvement.…”