Assessment of needs of men for decision support on male sterilization

Initiating male contraception methods

Non-surgical (reversible) male contraception methods, when approved for general clinical application, should be made available to all interested men aged 18 50 years in good general health regardless of their semen parameters. In the preliminary workup, a complete personal and family history aimed at identifying specific conditions that may potentially increase the risks for adverse effects (associated with testosterone replacement) is advisable but a general or andrological examination is not required, unless indicated by the history. Baseline body weight, blood pressure and haemoglobin should be recorded for the purpose of future monitoring. While risks and benefits of vasectomy have been well established, appropriately nuanced patient counselling and assessment are essential for ensuring a satisfactory outcome of vasectomy.

Male or female sterilization - the decision making process: Counselling and regret

OBJECTIVE(S)

To analyze the decision-making process of both male and female sterilization in order to improve counselling and prevent regret after sterilization in the future.

STUDY DESIGN

An online questionnaire regarding sterilization (counselling, sources of information and regret) was promoted on Facebook, Twitter and LinkedIn. A total of 1107 men and women who had undergone or considered sterilization in the Netherlands filled in the questionnaire.

RESULTS

A total of 88.9 % of the sterilized group and 67.4 % in the considered group responded that they felt well informed when they considered sterilization. However, less than half of the participants in both groups knew about all different sterilization methods. In both groups participants reported they consulted their partner the most when they considered sterilization. After sterilization 7.7 % reported having regret. Regret was reported more often when participants were sterilized ≤ 30 years. Most important reasons for regret reported by males were complications, pain, a new wish to conceive and divorce/remarriage. Most important reasons for regret reported by females were pain, complications, a new wish to conceive and menstrual symptoms. A total of 21.1 % in the sterilized and 38.0 % in the considered group responded they would have liked to use a decision aid when they considered sterilization.

CONCLUSIONS

Findings of this study provide insight in the decision-making process regarding sterilization. There is a lack of knowledge of different methods of sterilization and 7.7% regrets their sterilization afterwards. Furthermore, the results show an importance of developing a decision aid for couples considering sterilization.

Assessing Vasectomy-Related Information on YouTube: An Analysis of the Quality, Understandability, and Actionability of Information

This study aims to critically appraise the quality of vasectomy-related health information currently available on YouTube to better address patient information needs moving forward. A YouTube search was performed using the keyword “vasectomy.” The first 100 videos were assessed, with irrelevant and duplicate videos excluded. Two independent reviewers evaluated the remaining videos using the DISCERN instrument for evaluating the quality of information and the Patient Education Materials Assessment Tool for Audiovisual materials (PEMAT-A/V) for assessing the understandability and actionability of materials. Source characteristics and markers of bias and misinformation were also collected. Seventy-eight videos were included in the study, with a mean duration of 6.6 minutes and mean of 216,672 views. The median DISCERN score was poor at 28 (IQR 22–33) out of a possible 80 with mean PEMAT-AV Understandability and Actionability scores of 67.6% (±16.7%) and 33.8% (±36.2%), respectively. A medical doctor was present in 61 (78.2%) of the videos, of which 53 (86.9%) were urologists and 38 (62.2%) promoted their personal practice or institution. False statements regarding vasectomy were made in 14 (17.9%) videos. Notably, no significant difference was noted in quality, understandability, or actionability of videos created by those with personal promotion to those without. The quality of information regarding vasectomy on YouTube is poor and reaches a wide audience. Continued appraisal and creation of YouTube videos that contain quality, understandable and actionable information by urologists is necessary to ensure patients are well-informed.

Shared decision-making in gout treatment: a national study of rheumatology provider opinion and practice

To assess rheumatologists' views and practices related to shared decision-making (SDM) in gout treatment. We performed a cross-sectional electronic survey of rheumatologists at U.S. Veterans Affairs (VA) medical centers, assessing views and practices related to SDM in gout. Of the 154 VA rheumatology providers eligible, 90 responded (response rate, 58%). Fifty-eight percent were female, the mean age was 51 years (standard deviation, 9.6), 42% had > 20 years of experience in medical practice. Rheumatologists reported routinely offering a choice to their patients for (1) starting urate-lowering therapy (ULT) for gout vs. doing nothing (70%); (2) choosing NSAIDs, corticosteroids, or colchicine for the treatment of acute flares (67%); and (3) choosing NSAIDs, corticosteroids, or colchicine for anti-inflammatory prophylaxis when starting ULT (51%). Very few rheumatologists offered choice regarding (4) choosing allopurinol vs. febuxostat as the first ULT (16%) and (5) taking daily ULT long-term vs. intermittently (15%). Rheumatologists perceived that a large proportion of patients were often or sometimes unsure of the best choice for these five decisions, 34%, 76%, 76%, 52%, and 54%, respectively. Similar proportions of rheumatologists felt that patients were uninformed about both medication benefits and risks, unclear about the personal importance of the benefits and risks, and unsupported in decision-making. For the five decisions respectively, rheumatologists supported SDM with patients in 76%, 56%, 58%, 27%, and 25%. The majority of VA rheumatologists incorporated SDM in several gout treatment decisions. Rheumatologists also recognized that patients need better support to participate in SDM in gout. Key Points: • Rheumatologists offered shared decision-making to gout patients for 3 key treatment decisions. • Rheumatologists perceived that many patients were unsure of the best choice for these decisions. • Rheumatologists felt that patients were uninformed about medication benefits/risks and unsupported in decision-making.

Decisional conflict in breast cancer patients considering immediate breast reconstruction

Background

Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC).

Methods

Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict).

Results

Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p < .01), with no preference for or against breast reconstruction (OR = 11.84, p < .01), and with a strong preference for no breast reconstruction (OR = 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR = 1.03, p = .01).

Conclusion

A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction.

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A majority of patients considering immediate breast reconstruction experience decisional conflict.

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Patients without a strong preference for breast reconstruction are more likely to experience decisional conflict.

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Patients with more anxiety are more likely to experience decisional conflict.

20th Anniversary Update of the Ottawa Decision Support Framework Part 1: A Systematic Review of the Decisional Needs of People Making Health or Social Decisions

Background. The Ottawa Decision Support Framework (ODSF) has been used for 20 years to assess and address people’s decisional needs. The evidence regarding ODSF decisional needs has not been synthesized. Objectives. To synthesize evidence from ODSF-based decisional needs studies, identify new decisional needs, and validate current ODSF decisional needs. Methods. A mixed-studies systematic review. Nine electronic databases were searched. Inclusion criteria: studies of people’s decisional needs when making health or social decisions for themselves, a child, or a mentally incapable person, as reported by themselves, families, or practitioners. Two independent authors screened eligibility, extracted data, and quality appraised studies using the Mixed Methods Appraisal Tool. Data were analyzed using narrative synthesis. Results. Of 4532 citations, 45 studies from 7 countries were eligible. People’s needs for 101 unique decisions (85 health, 16 social) were reported by 2857 patient decision makers ( n = 36 studies), 92 parent decision makers ( n = 6), 81 family members ( n = 5), and 523 practitioners ( n = 21). Current ODSF decisional needs were reported in 2 to 40 studies. For 6 decisional needs, there were 11 new (manifestations): 1) information (overload, inadequacy regarding others’ experiences with options), 2) difficult decisional roles (practitioner, family involvement, or deliberations), 3) unrealistic expectations (difficulty believing outcome probabilities apply to them), 4) personal needs (religion/spirituality), 5) difficult decision timing (unpredictable), and 6) unreceptive decisional stage (difficulty accepting condition/need for treatment, powerful emotions limiting information processing, lacking motivation to consider delayed/unpredictable decisions). Limitations. Possible publication bias (only peer-reviewed journals included). Possible missed needs (non-ODSF studies, patient decision aid development studies, 3 ODSF needs added in 2006). Conclusion. We validated current decisional needs, identified 11 new manifestations of 6 decisional needs, and recommended ODSF revisions.

Exploring young women's decisional needs for contraceptive method choice: a qualitative study

OBJECTIVE

Assisting women with choosing contraceptive methods that meet their needs and preferences is essential to providing patient-centered care, but research to inform interventions supporting method choice is lacking. An assessment of patient decisional needs for contraceptive method choice may provide insight into patient-centered ways to support decision making.

STUDY DESIGN

Using the Ottawa Decision Support Framework as a guide, we conducted a qualitative study with semistructured interviews to identify women's decisional needs for choosing a contraceptive method. The sample consisted of 21 women aged 18-29 from an integrated health care delivery system. We employed thematic analysis to identify common themes in the participants' experience.

RESULTS

Overall, participants perceived choosing a contraceptive method to be a somewhat difficult decision and described feeling hesitant and unsure. Lack of knowledge of and familiarity with methods and the unpredictability of side effects contributed to participants' hesitancy. Women considered method choice in the context of their lives and their values for various contraceptive attributes, particularly side effects. Participants identified several sources for contraceptive information. Information from friends and family was highly influential. Participants desired both factual and experiential information.

CONCLUSIONS

Contraceptive method choice may be difficult for many young women, suggesting a need for decision support. Interventions supporting method choice may be more relevant if they directly address knowledge gaps and uncertainty as well as provide both factual and experiential information on a comprehensive set of contraceptive attributes.

Mexican Men's View of Vasectomy

The present study explored the views of Mexican men concerning vasectomy. One hundred and five men who had not had a vasectomy were asked to complete the following phrase "If you no longer wanted to have more children and a vasectomy was suggested, you would react with . . . or you would think . . . " with at least five different answers. Participants then had to rank each of their answers according to how well they describe the participant's feelings in the hypothetical situation. The results were analyzed using the Natural Semantic Networks Technique. The most common words used by participants with a limited educational background were reject, followed by fear and anger, and they did not use any words that implied acceptance of vasectomy. In contrast, the most common words used by participants with higher education were curiosity, followed by acceptance and interest; however, they also used the words fear and insecurity. The most frequent attitudes reported by men with limited education were negative, whereas participants with a higher education reported more ambivalent attitudes. These findings are discussed in light of sociocultural features and could be helpful in designing reproductive health programs with more effective counseling to diminish negative views about vasectomy.

Decisional conflict in asthma patients: a cross sectional study

OBJECTIVE

This study aimed at determining the level of decisional conflict in asthmatic individuals facing recommendation-based decisions provided to improve asthma control.

METHODS

This was a cross-sectional study performed on a convenience sample of 50 adults aged between 18 and 65 years with a diagnosis of asthma. They completed a decisional conflict scale (possible range of 0-100%), asthma knowledge and control questionnaires (both 0% and 100%), and a general questionnaire on socio-demographic characteristics. A decisional conflict was considered clinically significant with a score greater than 37.5%. Simple descriptive statistics were used to investigate associations with decisional conflict.

RESULTS

Participants were mainly women (76%) and diagnosed with mild asthma (72%). The median age (1st and 3rd quartile) was 25 years (22 and 42). The median score (1st and 3rd quartile) of decisional conflict was 33% (24 and 44). A clinically significant score (>37.5%) was obtained in 36% of subjects. A statistically significant negative correlation between the knowledge score and the decisional conflict score (r(p) = -0.38; p = 0.006) was observed. The level of knowledge was the only statistically independent variable associated with the decisional conflict score (p = 0.0043).

CONCLUSIONS

A considerable proportion of patients with asthma have a clinically significant level of decisional conflict when facing decisions aimed at improving asthma control. Patients with poor knowledge of asthma are more at risk of clinically significant level of decisional conflict. These findings support the relevance of providing asthmatic patients with relevant information in decision aids.

Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients

BACKGROUND

We sought to determine the psychometric properties of SURE, a 4-item checklist designed to screen for clinically significant decisional conflict in clinical practice.

METHODS

This study was a secondary analysis of a clustered randomized trial assessing the effect of DECISION+2, a 2-hour online tutorial followed by a 2-hour interactive workshop on shared decision making, on decisions to use antibiotics for acute respiratory infections. Patients completed SURE and also the Decisional Conflict Scale (DCS), as the gold standard, after consultation. We evaluated internal consistency of SURE using the Kuder-Richardson 20 coefficient (KR-20). We compared DCS and SURE scores using the Spearman correlation coefficient. We assessed sensitivity and specificity of SURE scores (cut-off score ≤3 out of 4) by identifying patients with and without clinically significant decisional conflict (DCS score >37.5 on a scale of 0-100).

RESULTS

Of the 712 patients recruited during the trial, 654 completed both tools. SURE scores showed adequate internal consistency (KR-20 coefficient of 0.7). There was a significant correlation between DCS and SURE scores (Spearman's ρ = -0.45, P < 0.0001). The prevalence of clinically significant decisional conflict as estimated by the DCS was 5.2% (95% CI 3.7-7.3). Sensitivity and specificity of SURE ≤3 were 94.1% (95% CI 78.9-99.0) and 89.8% (95% CI 87.1-92.0), respectively.

CONCLUSIONS

SURE shows adequate psychometric properties in a primary care population with a low prevalence of clinically significant decisional conflict. SURE has the potential to be a useful screening tool for practitioners, responding to the growing need for detecting clinically significant decisional conflict in patients.

Decisional conflict among patients who accept or decline participation in phase I oncology studies

WE COMPARED DECISIONAL CONFLICT among adults with advanced cancer who had accepted or declined participation in phase I cancer clinical trials. Respondents completed a 121-item questionnaire that included the Decisional Conflict Scale (DCS), which was designed to measure uncertainty in making health decisions. We used standardized effect sizes to compare the DCS scores of accepters (n = 250) and decliners (n = 65). Accepters had lower decisional conflict than decliners overall (d = 0.42; 95% confidence interval, 0.17--0.68) and on all subscales. Whether greater decisional conflict among decliners represents suboptimal decision-making and is reason for bioethical concern depends on how the results are interpreted. We offer three scenarios to explain the differences and describe opportunities for future empirical work.

Evaluation of the effect of a patient decision aid about vasectomy on the decision-making process: a randomized trial

BACKGROUND

Between 7% and 10% of men who choose vasectomy as a contraceptive method regret their decision. This study evaluates the effect of a patient decision aid (PtDA) designed to help men decide whether or not to have a vasectomy.

STUDY DESIGN

Men considering vasectomy were randomized to an experimental group that received a full PtDA containing information and values guidance (n=32) or to a control group that received an abridged PtDA containing information only (n=31).

RESULTS

Mean Decisional Conflict Scale (DCS) scores before and after the intervention were 2.6±0.4 and 1.9±0.4 in the experimental group and 2.5±0.4 and 1.8±0.4 in the control group (p=.94), respectively. Mean knowledge of vasectomy scores before and after the intervention were 50%±16% and 72%±18% in the experimental group and 55%±18% and 71%±15% in the control group (p=.40), respectively. At baseline, all participants were undecided as to whether to have a vasectomy. After the intervention, 60% of experimental group participants and 53% of control group participants had made a definite decision (p=.58).

CONCLUSION

In men considering vasectomy, both versions of the PtDAs improved the quality of decision-making process to a similar extent. Information alone may be sufficient to support good decision making in these patients.