Decisional Conflict in Parents Considering Bone-Anchored Hearing Devices in Children With Unilateral Aural Atresia

Graham, M. Elise; Haworth, Rebecca; Chorney, Jill; Bance, Manohar; Hong, Paul

doi:10.1177/0003489415592000

Cited by 23 publications

(33 citation statements)

References 15 publications

(20 reference statements)

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“…This study suggests, as in previous studies, that patient and physician estimates of SDM were not well correlated (correlation coefficient 0.234) [15, 18, 24]. Patients overall rated a higher level of SDM than physicians did.…”

Section: Discussionsupporting

confidence: 70%

“…This has also been shown in pediatric urology, with nearly a third of parents considering hypospadias repair for their child experiencing decisional conflict [16]. The proportion of patients with significant decisional conflict in the current study compares with data on pediatric patients undergoing elective procedures [15] but is less than adult patients considering thyroidectomy for indeterminate nodules, (34%) [17], or pediatric patients considering bone anchored hearing aids (43.5%) [18] or otoplasty (32.8%) [25]. The degree of conflict experienced by patients appears to vary considerably depending on the condition and ramifications of surgery.…”

Section: Discussionmentioning

confidence: 57%

“…Decisional conflict was significantly correlated with parental perception of SDM, with patients feeling more involved in the surgical decision experiencing significantly less decisional conflict. In parents specifically considering bone anchored hearing devices for their child with aural atresia, over 40% reported experiencing significant decisional conflict [18]. This has also been shown in pediatric urology, with nearly a third of parents considering hypospadias repair for their child experiencing decisional conflict [16].…”

Section: Discussionmentioning

confidence: 99%

“…Data on decisional conflict and shared decision making in patients with otolaryngology disorders is limited [15, 17, 18]. These, and studies in other surgical decision-making contexts have shown that patients experience significant decisional conflict when deciding between surgical and non-surgical treatment for various conditions [16].…”

Section: Discussionmentioning

confidence: 99%

“…Previous data has suggested that the degree of decisional conflict experienced by patients may be influenced by the degree of shared decision-making in patient consultation [16–18], with those patients perceiving more SDM experiencing less decisional conflict. Studies in other surgical decision-making contexts have showed that patients experience significant decisional conflict when deciding between surgical and non-surgical treatment for various conditions [17, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

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Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: a prospective cohort study

Graham

Westerberg

Lea

et al. 2018

J of Otolaryngol - Head & Neck Surg

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BackgroundPatients with vestibular schwannomas (VS) are faced with complex management decisions. Watchful waiting, surgical resection, and radiation are all viable options with associated risks and benefits. We sought to determine if patients with VS experience decisional conflict when deciding between surgery or non-surgical management, and factors influencing the degree of decisional conflict.MethodsA prospective cohort study in two tertiary ambulatory skull-base clinics was performed. Patients with newly diagnosed or newly growing vestibular schwannomas were recruited. Patients were given a demographic form and the decisional conflict scale (DCS), a validated measure to assess the degree of uncertainty when making medical decisions. The degree of shared decision making (SDM) experienced by the patient and physician were assessed via the SDM-Q-10 and SDM-Q-Doc questionnaires, respectively. Non-parametric statistics were used. Questionnaires and demographic information were correlated with DCS using Spearman correlation coefficient and Mann-Whitney U. Logistic regression was performed to determine factors independently associated with DCS scores.ResultsSeventy-seven patients participated (55% female, aged 37–81 years); VS ranged in size from 2 mm–50 mm. Significant decisional conflict (DCS score 25 or greater) was experienced by 17 (22%) patients. Patients reported an average SDM-Q-10 score of 86, indicating highly perceived level of SDM. Physician and patient SDM scores were weakly correlated (p = 0.045, Spearman correlation coefficient 0.234). DCS scores were significantly negatively correlated with a decision to pursue surgery, presence of a trainee, and higher SDM-Q-10 score. DCS was higher with female gender. Using logistic regression, the SDM-Q-10 score was the only variable associated with significantly reduced DCS.ConclusionsAbout one fifth of patients deciding how to manage their vestibular schwannoma experienced a significant degree of decisional conflict. Involving the patients in the process through shared decision-making significantly reduced the degree of uncertainty patients experienced.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: a prospective cohort study

Graham

Westerberg

Lea

et al. 2018

J of Otolaryngol - Head & Neck Surg

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Patients’ Views of Shared Decision-making and Decisional Conflict in Otolaryngologic Surgery During the COVID-19 Pandemic

Wamkpah

Gerndt

Kallogjeri

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE A patient's decision to undergo surgery may be fraught with uncertainty and decisional conflict. The unpredictable nature of the COVID-19 pandemic warrants further study into factors associated with patient decision-making.OBJECTIVE To assess decisional conflict and patient-specific concerns for people undergoing otolaryngologic surgery during the pandemic. DESIGN, SETTING, PARTICIPANTSThis prospective cross-sectional survey study was conducted via telephone from April 22 to August 31, 2020. English-speaking adults scheduled for surgery from a single academic surgical center were invited to participate. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, scheduled for emergent surgery, or had a communication disability were excluded. For race and ethnicity reporting, participants were classified dichotomously as White according to the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention or non-White as a collective term including Black or African American, American Indian or Alaska Native, Asian, or Pacific Islander race and ethnicity.EXPOSURES The SURE Questionnaire (sure of myself, understand information, risks/benefits ratio, and encouragement) was used to screen for decisional conflict, with a total score greater than or equal to 3 indicating clinically significant decisional conflict. Participants were asked to share their specific concerns about having surgery. MAIN OUTCOME AND MEASURESDecisional conflict and patient demographic data were assessed via bivariate analyses, multivariable logistic regression and conjunctive consolidation. Patient-specific concerns were qualitatively analyzed for summative themes. RESULTSOf 444 patients screened for eligibility, 182 (40.9%) respondents participated. The median age was 60.5 years (interquartile range, 48-70 years). The racial and ethnic identity of the participants was classified as binary White (84% [153 of 182]) and non-White (16% [29 of 182]). The overall prevalence of decisional conflict was 19% (34 of 182). Decisional conflict was more prevalent among non-White than White participants (proportion difference 18.8%, 95% CI, 0.6%-37.0% and adjusted odds ratio 3.0; 95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non-White patients with no college education receiving urgent surgery (odds ratio, 10.8; 95% CI, 2.6-45.0). Intraoperative and postoperative concerns were the most common themes expressed by participants. There was a clinically significant difference in the proportion of participants who screened positive for decisional conflict (30%) and expressed postoperative concerns than those who screened negative for decisional conflict (17%) (proportion difference, 13%; 95% CI, 1%-25%). Among patients reporting concerns about COVID-19, most screened positive for decisional conflict.CONCLUSIONS AND RELEVANCE Results of this cross-sectional survey study suggest t...

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Shared decision making in primary malignant bone tumour surgery in children and young adults

Blom,

Bekkering,

Hagemeijer

et al. 2024

EJC Paediatric Oncology

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Decisional Conflict in Parents Considering Bone-Anchored Hearing Devices in Children With Unilateral Aural Atresia

Abstract: Many parents experienced significant decisional conflict when considering percutaneous BAHD surgery in children with unilateral aural atresia in our study population. Future research should explore the impact of decisional conflict on health outcomes.

Cited by 23 publications

References 15 publications

Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: a prospective cohort study

Shared decision making and decisional conflict in the Management of Vestibular Schwannoma: a prospective cohort study

Patients’ Views of Shared Decision-making and Decisional Conflict in Otolaryngologic Surgery During the COVID-19 Pandemic

Shared decision making in primary malignant bone tumour surgery in children and young adults

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