Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations

Abstract

Objectives: Numerous therapies exist for adult obstructive sleep apnea (OSA), creating potential for patient decisional conflict (DC) that impacts treatment adherence and post-treatment regret. We evaluated the prevalence of elevated DC in OSA patients presenting for positive airway pressure (PAP) alternative therapies and identified gaps in available resources about OSA therapies.Study Design: Cross-sectional study. Methods: A cross-sectional study was performed based on questionnaires completed by adult OSA patients presenting to an academic sleep surgery clinic from March to October 2020. Surveys examined sleep symptoms, sleep apnea treatment history, goals of therapy, and the SURE checklist, a validated 4-item DC screening scale. Additional qualitative data about OSA decision tool needs were queried with structured interviews in a smaller subset of patients.Results: Among 100 respondents, 60 were open to multiple treatment options, whereas 22 were not interested in surgical treatment. Eighty-one respondents (81%) had elevated DC (SURE score < 4). High DC was not associated with CPAP history, OSA severity, or daytime sleepiness (Epworth Sleepiness Scale score ≥ 10). Elevated DC was related to uncertainty regarding optimal treatment choice in 54% of respondents (n = 54), and lack of knowledge regarding risks and benefits of each treatment option in 71% (n = 71). Common themes identified in 9 interviewed patients suggested helpful resources should ideally compare treatment modalities and educate on surgery details, efficacy, and recovery.Conclusions: The majority of OSA patients presenting to sleep surgery clinics have elevated decisional conflict influenced by limited knowledge about options and the risks and benefits of each therapy. There is a need for decision tools that can reduce decisional conflict and promote equitable knowledge about PAP alternative OSA treatments.

Patient‐Defined Goals for Obstructive Sleep Apnea Treatment

“…11 These aspects of SDM are especially pertinent to patients presenting for sleep surgery consultation, many of whom feel that they lack adequate understanding about treatment options and have a high prevalence of decisional conflict. 1 Despite the importance of SDM in adult OSA treatment planning, few data exist regarding treatment preferences and values in this population, especially for patients considering surgery. Alignment of patient-specific treatment goals to therapeutic options and expectations is essential in conversations about treatment recommendations.…”

“…Future work should also investigate the influence of prior patient education and research on treatment goals and decision making. 1 …”

“…Improved decision quality has been linked to increased treatment compliance, reduced regret, and fewer appointment or surgery cancellations 11 . These aspects of SDM are especially pertinent to patients presenting for sleep surgery consultation, many of whom feel that they lack adequate understanding about treatment options and have a high prevalence of decisional conflict 1 . Despite the importance of SDM in adult OSA treatment planning, few data exist regarding treatment preferences and values in this population, especially for patients considering surgery.…”

“…We previously demonstrated high rates of decisional conflict and the potential for decision delay or regret in this population. 1 …”

“…We previously demonstrated high rates of decisional conflict and the potential for decision delay or regret in this population. 1 Thus, there is a need to improve patient preparedness for decision making and decision quality through better shared decision-making (SDM) processes and tools. Key components of the patient-centered SDM process include understanding patient preferences and treatment goals to enhance patient education, promote patient engagement, and align definitions of optimal outcomes.…”