Effect of patient decision aids on decisional conflict and regret associated with breast cancer surgery: a randomized controlled trial

Lin, Shi-Qian; Su, Chih-Ming; Wu, Hsueh-Chi; Chou, Y.-H.; Yen, Yu-Chun; Tam, Ka‐Wai

doi:10.1007/s12282-022-01370-0

Cited by 9 publications

(3 citation statements)

References 33 publications

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“…It has high reliability (Cronbach α, 0.81-0.92) and is well correlated with decision satisfaction, decisional conflict, and overall rated quality of life . The instrument has been used extensively for oncologic screening and treatment decisions as well as in nonclinical contexts …”

Section: Methodsmentioning

confidence: 99%

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Bruce,

Khouri,

Bolze

et al. 2023

JAMA Surg

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ImportanceThere has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments.ObjectiveTo evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy.Design, Setting, and ParticipantsFor this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020.ExposureDecisional regret and satisfaction with decision to undergo gender-affirming mastectomy.Main Outcomes and MeasuresLong-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders.ResultsA total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P &lt; .001) and anxiety (42 [44%] vs 97 [70%]; P &lt; .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses.Conclusions and RelevanceIn this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.

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Section: Methodsmentioning

confidence: 99%

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Bruce,

Khouri,

Bolze

et al. 2023

JAMA Surg

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“…Currently, there is increasing interest in decision aids for screening and treating chronic diseases, such as breast cancer (Elkin et al, 2017;Lin et al, 2022;Osaka & Nakayama, 2017;Sivell et al, 2012), stroke (Saposnik et al, 2016;Schott et al, 2019)and diabetes (Buse et al, 2021;Colmegna et al, 2023;Yu et al, 2020). However, there is lack of a systematic review of the characteristics, content and effectiveness of ACP decision aids applied in the field of palliative care.…”

Section: What Does This Paper Contribute To the Wider Global Clinical...mentioning

confidence: 99%

Exploration of decision aids to support advance care planning: A scoping review

Xu,

Han,

et al. 2024

Journal of Clinical Nursing

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BackgroundAdvance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision‐making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options.ObjectiveWhile decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research.DesignScoping review.MethodsThis scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA‐ScR list. Six English‐language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries.ResultsOf the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision‐making process satisfaction, but their feasibility has yet to be tested.ConclusionsDecision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision‐making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application.Reporting MethodThe paper has adhered to the EQUATOR guidelines and referenced the PRISMAg‐ScR checklist.No Patient or Public ContributionThis is a review without patient and public contribution.Registration: https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF.

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“…Several studies have examined the role of decisional conflict in patient decision-making, particularly for cancer surgery. 11-14 These studies underscore the relationship between decisional conflict and decision quality, satisfaction, and regret. Elevated decisional conflict has also been associated with worse quality of life.…”

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confidence: 96%

Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

Feinberg,

Gessner,

Deal

et al. 2024

Journal of Urology

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Purpose: Because multiple management options exist for clinical T1 renal masses, patients may experience a state of uncertainty about the course of action to pursue (ie, decisional conflict). To better support patients, we examined patient, clinical, and decision-making factors associated with decisional conflict among patients newly diagnosed with clinical T1 renal masses suspicious for kidney cancer. Materials and Methods: From a prospective clinical trial, participants completed the Decisional Conflict Scale (DCS), scored 0 to 100 with < 25 associated with implementing decisions, at 2 time points during the initial decision-making period. The trial further characterized patient demographics, health status, tumor burden, and patient-centered communication, while a subcohort

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Effect of patient decision aids on decisional conflict and regret associated with breast cancer surgery: a randomized controlled trial

Cited by 9 publications

References 33 publications

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

Exploration of decision aids to support advance care planning: A scoping review

Decisional Conflict Among Patients Newly Diagnosed With Clinical T1 Renal Masses: A Prospective Study

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