Decisional conflict in economically disadvantaged men with newly diagnosed prostate cancer: Baseline results from a shared decision-making trial

6059 Background: The high CaP incidence and mortality of black men combined with their relatively low rate of CaP screening and their elevated risk of presenting with advanced disease has led to their being identified as a high-priority group for screening. The benefit of screening, however, is uncertain. Most guidelines recommend that men make an individualized screening decision in consultation with their doctor. Motivating and preparing men to actively participate in this difficult decision remains a challenge. This is particularly relevant regarding black Americans given their historical alienation from the health care system. Methods: A CaP screening decision aid designed to promote shared decision-making was tested in 5 small group sessions of black men at community sites in Boston. The decision aid was preceded by a brief didactic presentation on CaP screening. The decision aid included a graphical depiction of all potential major outcomes that may follow a decision for or against screening. Vignettes about the decision-making and outcomes of hypothetical men with different life circumstances and priorities were presented to enhance values clarification by the participants. Endpoints measured before and after the intervention included self efficacy (SE)[Decision Self Efficacy Scale], decisional conflict (DC) [Decisional Conflict Scale], desire for autonomy (DFA) [Control Preferences Scale], and prostate cancer knowledge (PCK) [Prostate Cancer Knowledge and Prostate Cancer Screening Knowledge scales]. Pre- and post-intervention scores were compared using a Wilcoxon Matched-Pairs Signed Rank test. Results: 64 men were accrued over 4 months during 2005. Significant changes were seen in all measures. Average scores improved 16% on SE (p<.001) and 17% on DC (p<.004). DFA increased, with the proportion of men wanting to play a dominant role in health care decisions rising from 62% to 81% (p<.001). PCK more than doubled on both scales (p<.001). Focus groups held after the intervention reinforced these findings. Conclusions: Men were better informed, felt better prepared to actively participate in CaP screening decisions, and wanted to play a stronger role in decisions about their health care following exposure to our decision aid. No significant financial relationships to disclose.

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HSR&D Study Identifies Barriers to Shared Decision-Making Among Newly Diagnosed Prostate Cancer Patients

PsycEXTRA Dataset ◽

10.1037/e578252006-006 ◽

2004 ◽

Author(s):

Charles L. Bennett ◽

Allison Lyons

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision ◽

Newly Diagnosed

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Decision-making in imminent extreme premature births: perceived shared decision-making, parental decisional conflict and decision regret

Journal of Perinatology ◽

10.1038/s41372-021-01159-7 ◽

2021 ◽

Author(s):

R. Geurtzen ◽

J. F. M. van den Heuvel ◽

J. J. Huisman ◽

E. M. Lutke Holzik ◽

M. N. Bekker ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decisional Conflict ◽

Premature Births ◽

Shared Decision ◽

Decision Regret

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Impact of an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes on decisional conflict – study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-015-0797-8 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 11

Author(s):

Catherine H. Yu ◽

Noah M. Ivers ◽

Dawn Stacey ◽

Jeremy Rezmovitz ◽

Deanna Telner ◽

...

Keyword(s):

Decision Making ◽

Randomized Controlled Trial ◽

Shared Decision Making ◽

Goal Setting ◽

Decision Aid ◽

Controlled Trial ◽

Decisional Conflict ◽

Shared Decision ◽

Randomized Controlled ◽

Patients With Diabetes

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EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1090 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S296-S297

Author(s):

Ruth E Pel-Littel ◽

Bianca Buurman ◽

Marjolein van de Pol ◽

Linda Tulner ◽

Mirella Minkman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Observational Study ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decisional Conflict ◽

Future Research ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

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PD40-07 ADDRESSING HEALTH LITERACY IMPROVES SHARED DECISION MAKING IN UNDERSERVED AFRICAN AMERICAN PROSTATE CANCER PATIENTS

The Journal of Urology ◽

10.1097/ju.0000000000000920.07 ◽

2020 ◽

Vol 203 ◽

pp. e817-e818

Author(s):

Kerry Kilbridge ◽

William Martin-Doyle* ◽

Christopher Filson ◽

Quoc-Dien Trinh ◽

Sierra Williams ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

Health Literacy ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision

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The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

Medical Decision Making ◽

10.1177/0272989x18796223 ◽

2018 ◽

Vol 38 (8) ◽

pp. 1040-1045 ◽

Cited By ~ 6

Author(s):

Alyce Mei-Shiuan Kuo ◽

Berry Thavalathil ◽

Glyn Elwyn ◽

Zsuzsanna Nemeth ◽

Stuti Dang

Keyword(s):

Decision Making ◽

Electronic Health Records ◽

Shared Decision Making ◽

Decisional Conflict ◽

Shared Decision ◽

Health Records ◽

Look Ahead ◽

The Face ◽

Electronic Health ◽

The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

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