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Patil A, Chawathey S, Malim A. Adequacy of Informed Consent in Elective Surgical Procedures: A Study in a Navi Mumbai Tertiary Care Centre. Cureus 2023; 15:e41777. [PMID: 37449289 PMCID: PMC10337701 DOI: 10.7759/cureus.41777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Background Informed consent (IC) is a voluntary authorisation given by a patient or research subject after fully comprehending the risks involved in various procedures and treatments. Though a patient may fulfill all the aspects of consent by completing an informed consent form (ICF), research indicates poor execution of the IC process by ill-informed patients with little comprehension. The present study was done on patients to assess their understanding and involvement in the consenting process, thereby providing insight into the adequacy and sufficiency of the IC process. Materials and methodology Patients undergoing elective surgical procedures were surveyed using a questionnaire to study whether the written informed consent (IC) process was adequately used in elective surgeries and to assess the patient's understanding of the IC and whether the informed consent forms (ICF) used met the ethical and legal standards for this purpose. The questionnaire was administered to the patients by two surveyors. As per the inclusion/exclusion criteria, data was collected from 221 admitted patients who were planned to undergo or recently underwent various elective surgical/operative procedures. Descriptive analysis using frequency and percentages of the positive and negative responses was used to analyse the data. Results In 219 (99%) of the cases, informed consent was taken. Two hundred-eight patients (94.1%) understood the knowledgeable consent information, while 13 (5.9%) did not. Of the total 221 patients, more than 90% of patients were informed about the nature and indication of the surgery. The expected benefits were told to 83.25% of patients, while possible complications of the procedure were reported to 91 patients (41.2%). Of the total, 58.37 % of patients knew the type of anaesthesia used for elective surgery. Two hundred and sixteen (97.73%) patients favoured the informed consent process, and 213 (96.38%) were satisfied with the information provided in the consent form. The education status of the patient varied, with nearly 15.5% being illiterate while 35.3% being educated till high school. Patients undergoing surgical procedures must be explained the nature and indication of the proposed surgical treatment, including its benefits and risks. About 208 (94.1%) of the patients stated that they understood all the information provided in the ICF, and 213 patients (96.3%) were satisfied with it. Most patients (88.7%) exercised autonomy in deciding to undergo surgery. Ninety-seven percent of patients favoured the IC process, of which 38.46% believed informed consent has a medicolegal significance. Conclusion The present study revealed that a better understanding of the informed consent by the patients is a vital component of the process as it helps exercise autonomy in the decision-making process. However, the lack of information in the informed consent forms critically affects the quality and adequacy of the IC, thus posing ethical and legal challenges to genuinely informed consent.
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Affiliation(s)
- Amit Patil
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shreyas Chawathey
- Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, IND
| | - Adel Malim
- College of Medicine, Dr D Y Patil Medical College, Hospital, and Research Centre, Navi Mumbai, IND
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Barlet MH, Ubel PA, Weinfurt KP, Glass HC, Pollak KI, Brandon DH, Lemmon ME. Decisional Satisfaction, Regret, and Conflict Among Parents of Infants with Neurologic Conditions. J Pediatr 2022; 245:81-88.e3. [PMID: 35227757 PMCID: PMC9232962 DOI: 10.1016/j.jpeds.2022.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. STUDY DESIGN In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores. RESULTS We enrolled 61 parents of 40 infants (n = 40 mothers, n = 21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of 35) reported high decisional conflict. Mothers and fathers reported higher decisional conflict in the domains of uncertainty and values clarity compared with the domain of effective decision making (Bonferroni-corrected P < .05). There were no differences in decision outcomes between paired mothers and fathers; however, within any given couple, there were numerous instances of disagreement (7 of 15 for decision regret and 5 of 15 for decisional conflict). CONCLUSIONS Many parents experience decisional conflict even if they ultimately have high satisfaction and low regret, underscoring the need for decision aids targeting uncertainty and values clarity. Couples frequently experience different levels of decisional regret and conflict.
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Affiliation(s)
| | - Peter A. Ubel
- Duke University School of Medicine, Durham, NC, USA,Fuqua School of Business, Duke University, Durham, NC, USA,Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Kevin P. Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hannah C. Glass
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Debra H. Brandon
- Duke University School of Nursing, Durham, NC, USA,Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Monica E. Lemmon
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Fang JT, Chen SY, Tian YC, Lee CH, Wu IW, Kao CY, Lin CC, Tang WR. Effectiveness of end-stage renal disease communication skills training for healthcare personnel: a single-center, single-blind, randomized study. BMC MEDICAL EDUCATION 2022; 22:397. [PMID: 35606757 PMCID: PMC9125352 DOI: 10.1186/s12909-022-03458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP. METHODS For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations. RESULTS IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen's d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%). CONCLUSIONS ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.
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Affiliation(s)
- Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Lee
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chen-Yi Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Woung-Ru Tang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan.
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4
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Sherman KA, Kilby CJ, Pehlivan M, Smith B. Adequacy of measures of informed consent in medical practice: A systematic review. PLoS One 2021; 16:e0251485. [PMID: 34043651 PMCID: PMC8159027 DOI: 10.1371/journal.pone.0251485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
As a critical component of medical practice, it is alarming that patient informed consent does not always reflect (1) adequate information provision, (2) comprehension of provided information, and (3) a voluntary decision. Consequences of poor informed consent include low patient satisfaction, compromised treatment adherence, and litigation against medical practitioners. To ensure a well-informed, well-comprehended, and voluntary consent process, the objective and replicable measurement of these domains via psychometrically sound self-report measures is critical. This systematic review aimed to evaluate the adequacy of existing measures in terms of the extent to which they assess the three domains of informed consent, are psychometrically sound and acceptable for use by patients. Extensive searching of multiple databases (PsychINFO, PubMed, Sociological Abstracts, CINAHL, AMED) yielded 10,000 potential studies, with 16 relevant scales identified. No existing scale was found to measure all three consent domains, with most only narrowly assessing aspects of any one domain. Information provision was the most frequently assessed domain, followed by comprehension, and then voluntariness. None of the identified scales were found to have adequate evidence for either high quality psychometric properties or patient user acceptability. No existing scale is fit for purpose in comprehensively assessing all domains of informed consent. In the absence of any existing measure meeting the necessary criteria relating to information, comprehension and voluntariness, there is an urgent need for a new measure of medical consent to be developed that is psychometrically sound, spans all three domains and is acceptable to patients and clinicians alike. These findings provide the impetus and justification for the redesign of the informed consent process, with the aim to provide a robust, reliable and replicable process that will in turn improve the quality of the patient experience and care provided.
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Affiliation(s)
- Kerry A. Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
- * E-mail:
| | | | - Melissa Pehlivan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Brittany Smith
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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5
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Robertson EG, Cohen J, Signorelli C, Grant DM, Fardell JE, Wakefield CE. What instruments should we use to assess paediatric decision-making interventions? A narrative review. J Child Health Care 2020; 24:458-472. [PMID: 31450963 DOI: 10.1177/1367493519869717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an increasing number of shared decision-making (SDM) interventions in paediatrics. However, there is little consensus as to the best instruments to assess the feasibility and impact of these interventions. This narrative review aims to answer: (1) what feasibility, knowledge and decision-making instruments have been used to assess paediatric SDM interventions and (2) what are the psychometric properties of used decision-making instruments, guided by the 'consensus-based standards for the selection of health measurement instrument' criteria. We conducted a review of the peer-reviewed literature. We identified 23 studies that evaluated a paediatric intervention to facilitate SDM for a specific health decision. Eighteen studies assessed intervention feasibility, with a wide variability in assessment between studies. Twelve studies assessed objective knowledge, and four studies assessed subjective knowledge with all but one study aggregating correct responses. We identified nine decision-making instruments that had been assessed psychometrically, although few had been thoroughly evaluated. The Decisional Conflict Scale was the most commonly-used instrument and the only instrument evaluated in paediatrics. Our study revealed a lack of consistency in the instruments used to evaluate decision-making interventions in paediatrics, making it difficult to compare interventions. We provide several recommendations for researchers to improve the assessment of SDM interventions in paediatrics.
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Affiliation(s)
- Eden G Robertson
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Christina Signorelli
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - David M Grant
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Boland L, Légaré F, McIsaac DI, Graham ID, Taljaard M, Dècary S, Stacey D. SURE Test Accuracy for Decisional Conflict Screening among Parents Making Decisions for Their Child. Med Decis Making 2019; 39:1010-1018. [PMID: 31731879 DOI: 10.1177/0272989x19884541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. We aimed to validate the SURE test for use with parents in primary care. Methods. A secondary analysis of cluster randomized trial data was used to compare the SURE test (index, higher score = less conflict) to the Decisional Conflict Scale (DCS; reference, higher score = greater conflict). Our a priori hypothesis was that the scales would correlate negatively. We evaluated the association between scores and estimated the proportion of variance in the DCS explained by the SURE test. Then, we dichotomized each measure using established cutoffs to calculate diagnostic accuracy and internal consistency with confidence intervals adjusted for clustering. We evaluated the presence of effect modification by sex, followed by sex-specific calculation of validation statistics. Results. In total, 185 of 201 parents completed a DCS and SURE test. Total DCS (mean = 4.2/100, SD = 14.3) and SURE test (median 4/4; interquartile range, 4-4) scores were significantly correlated (ρ = -0.36, P < 0.0001). The SURE test explained 34% of the DCS score variance. Internal consistency (Kuder-Richardson 20) was 0.38 (P < 0.0001). SURE test sensitivity and specificity for identifying decisional conflict were 32% (95% confidence interval [CI], 20%-44%) and 96% (95% CI, 93%-100%), respectively. The SURE test's positive likelihood ratio was 8.4 (95% CI, 0.1-17) and its negative likelihood ratio was 0.7 (95% CI, 0.53-0.87). There were no significant differences between females and males in DCS (P = 0.5) or SURE test (P = 0.97) total scores; however, correlations between test total scores (-0.37 for females v. for -0.21 for males; P = 0.001 for the interaction) and sensitivity and specificity were higher for females than males. Conclusions. SURE test demonstrated acceptable psychometric properties for screening decisional conflict among parents making a health decision about their child in primary care. However, clinicians cannot be confident that a negative SURE test rules out the presence of decisional conflict.
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Affiliation(s)
- Laura Boland
- School of Health Studies, Western University, London ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital, Quebec City, QC, Canada
| | - Daniel I McIsaac
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada
| | - Simon Dècary
- Department of Family Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Schuler CL, Dodds C, Hommel KA, Ittenbach RF, Denson LA, Lipstein EA. Shared decision making in IBD: A novel approach to trial consent and timing. Contemp Clin Trials Commun 2019; 16:100447. [PMID: 31538130 PMCID: PMC6745512 DOI: 10.1016/j.conctc.2019.100447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Shared decision making (SDM) between families and physicians may facilitate informed, timely decisions to proceed with biologic therapy in children with inflammatory bowel disease (IBD). Our team previously developed an SDM tool to aid communication between physicians and families when considering biologic therapy for children with IBD. Objective We are conducting a prospective, pre-post pilot trial of a new SDM tool. The primary aim of the study is to assess feasibility of both the intervention and trial procedures for a future large-scale trial. Methods We are enrolling physicians with experience prescribing biologic therapy in the past year and families of children with IBD. Families in the intervention arm receive a 3-step intervention including a letter sent before trial consent or clinic appointment, an in-clinic decision tool and a follow-up phone call. Our primary trial outcome is a measure of feasibility, with measures of clinical and decision outcomes secondary. We seek to enroll 27 families in each of 2 arms (usual-care and intervention) and plan data collection at the time of the initial visit or hospital stay, and at 1 week, 3 months, and 6 months after the initial visit. Conclusion This study protocol is designed to demonstrate that integrating novel consent procedures, including timing and multiple versions of written consent, may increase trial feasibility while maintaining scientific rigor and full protection of study participants.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cassandra Dodds
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lee A Denson
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Pozzar RA, Berry DL, Hong F. Item response theory analysis and properties of decisional conflict scales: findings from two multi-site trials of men with localized prostate cancer. BMC Med Inform Decis Mak 2019; 19:124. [PMID: 31272447 PMCID: PMC6610903 DOI: 10.1186/s12911-019-0853-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 06/26/2019] [Indexed: 11/26/2022] Open
Abstract
Background Decisional conflict is associated with decision quality and may affect decision outcomes. In the health sciences literature, the Decisional Conflict Scale is widely used to measure decisional conflict, yet limited research has described the psychometric properties of the Decisional Conflict Scale subscales and of the low literacy version of the scale. The purpose of this secondary data analysis was therefore to examine properties of the original (DCS-12) and low literacy (LL DCS-10) Decisional Conflict Scales using Classical Measurement Theory and Item Response Theory. Methods Data from two multi-site trials of men with prostate cancer were used to analyze the DCS-12, LL DCS-10, and an aggregated DCS-12 dataset in which five response options were aggregated into three. Internal consistency was estimated with Cronbach’s alphas. Subscale correlations were evaluated with Pearson’s correlation coefficient. Item difficulty, item discrimination, and test information were evaluated using Graded Response Modeling (GRM). The likelihood ratio test guided model selection. Results Cronbach’s alphas for the total scales and three of four subscales were ≥ 0.85. Alphas ranged from 0.34–0.57 for the support subscales. Subscale correlations ranged from 0.42–0.71 (P < 0.001). Items on the DCS-12 exhibited the widest range of difficulty. Two items on the support subscale had low to moderate discrimination and contributed little information. Only the DCS-12 was informative across the full range of decisional conflict values. Conclusions Lack of precision in the support subscale raises concerns about subscale validity. The DCS-12 is most capable of discriminating between respondents with high and low decisional conflict. Evaluation of interventions to reduce decisional conflict must consider the above findings. Electronic supplementary material The online version of this article (10.1186/s12911-019-0853-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, USA. .,School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave., Boston, MA, USA.
| | - Donna L Berry
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, USA.,School of Nursing, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave., Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, USA
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Garvelink MM, Boland L, Klein K, Nguyen DV, Menear M, Bekker HL, Eden KB, LeBlanc A, O'Connor AM, Stacey D, Légaré F. Decisional Conflict Scale Use over 20 Years: The Anniversary Review. Med Decis Making 2019; 39:301-314. [PMID: 31142194 DOI: 10.1177/0272989x19851345] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Decisional Conflict Scale (DCS) measures 5 dimensions of decision making (feeling: uncertain, uninformed, unclear about values, unsupported; ineffective decision making). We examined the use of the DCS over its initial 20 years (1995 to 2015). Methods. We conducted a scoping review with backward citation search in Google Analytics/Web of Science/PubMed, followed by keyword searches in Cochrane Library, PubMed, Ovid MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, PRO-Quest, and Web of Science. Eligible studies were published between 1995 and March 2015, used an original experimental/observational research design, concerned a health-related decision, and provided DCS data (total/subscales). Author dyads independently screened titles, abstracts, full texts, and extracted data. We performed narrative data synthesis. Results. We included 394 articles. DCS use appeared to increase over time. Three hundred nine studies (76%) used the original DCS, and 29 (7%) used subscales only. Most studies used the DCS to evaluate the impact of decision support interventions (n = 238, 59%). The DCS was translated into 13 languages. Most decisions were made by people for themselves (n = 353, 87%), about treatment (n = 225, 55%), or testing (n = 91, 23%). The most common decision contexts were oncology (n = 113, 28%) and primary care (n = 82, 20%). Conclusions. This is the first study to descriptively synthesize characteristics of DCS data. Use of the DCS as an outcome measure for health decision interventions has increased over its 20-year existence, demonstrating its relevance as a decision-making evaluation measure. Most studies failed to report when decisional conflict was measured during the decision-making process, making scores difficult to interpret. Findings from this study will be used to update the DCS user manual.
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Affiliation(s)
- Mirjam M Garvelink
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
| | - Laura Boland
- Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Don Vu Nguyen
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK (HLB)
| | - Karen B Eden
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University (OHSU), Department of Medical Informatics & Clinical Epidemiology, Portland, OR, USA
| | | | | | - Dawn Stacey
- Faculty of Health Science, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
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10
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Pérez-Revuelta J, Villagrán-Moreno JM, Moreno-Sánchez L, Pascual-Paño JM, González-Saiz F. Patient perceived participation in decision making on their antipsychotic treatment: Evidence of validity and reliability of the COMRADE scale in a sample of schizophrenia spectrum disorders. PATIENT EDUCATION AND COUNSELING 2018; 101:1477-1482. [PMID: 29606551 DOI: 10.1016/j.pec.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/17/2018] [Accepted: 03/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this paper is to provide evidence of the validity and reliability of the COMRADE scale (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness) in patients suffering from schizophrenia spectrum disorders. METHOD 150 patients recruited at five mental health centers were assessed using a cross-sectional study design. The COMRADE, WAIS-S (therapeutic alliance) and TSQM (satisfaction with medication) scales were used. RESULTS Exploratory Factor Analysis identified three factors from the COMRADE (F1: "Risk communication"; F2: "Confidence in decision" and F3: "Knowledge of decisional balance") which explain 45.2, 8.5 and 6% of the variance, respectively. Statistically significant correlations were observed between the scores of the COMRADE subscales with the subscales of the WAI-S and the TSQM. The internal consistency observed for each of the factorial scores of the COMRADE were (Cronbach's alpha values) 0.90, 0.89 and 0.74, respectively. CONCLUSION The COMRADE scale offers appropriate psychometric properties for its use as a measure of perceived patient involvement in the shared decision making process in antipsychotic treatment. PRACTICE IMPLICATIONS The use of the COMRADE measure in psychiatric clinical practice and in research studies provides an outcome measure of interventions from the shared decision making model.
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Affiliation(s)
- José Pérez-Revuelta
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain.
| | - José María Villagrán-Moreno
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain; Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Spain.
| | - Luisa Moreno-Sánchez
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain.
| | - Juan Manuel Pascual-Paño
- Unidad de Hospitalización de Salud Mental, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain.
| | - Francisco González-Saiz
- Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Spain; Unidad de Salud Mental Comunitaria Villamartín, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Spain.
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11
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Gärtner FR, Bomhof-Roordink H, Smith IP, Scholl I, Stiggelbout AM, Pieterse AH. The quality of instruments to assess the process of shared decision making: A systematic review. PLoS One 2018; 13:e0191747. [PMID: 29447193 PMCID: PMC5813932 DOI: 10.1371/journal.pone.0191747] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. METHODS In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. RESULTS We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. CONCLUSIONS Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.
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Affiliation(s)
- Fania R. Gärtner
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hanna Bomhof-Roordink
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ian P. Smith
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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12
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Boland L, Kryworuchko J, Saarimaki A, Lawson ML. Parental decision making involvement and decisional conflict: a descriptive study. BMC Pediatr 2017; 17:146. [PMID: 28610580 PMCID: PMC5470309 DOI: 10.1186/s12887-017-0899-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/05/2017] [Indexed: 01/03/2023] Open
Abstract
Background Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child’s health. However, little is known about parents’ experience of decisional conflict. We explored parents’ perceived decision making involvement and its association with parents’ decisional conflict. Method We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Results Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p < 0.001). Further, parents with options were more likely to: feel sure about the decision (RR 1.08, 95% CI 1.02–1.15); understand the information (RR 1.92, 95% CI 1.63–2.28); be clear about the risks and benefits (RR 1.12, 95% CI 1.05–1.20); and, have sufficient support and advice to make a choice (RR 1.07, 95% CI 1.03–1.11). Conclusion Many parents in our sample experienced decisional conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents’ decisional conflict. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0899-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Boland
- University of Ottawa, Faculty of Health Sciences, Population Health, 125 University Street, room 232, Ottawa, ON, K1N 6N5, Canada
| | - Jennifer Kryworuchko
- University of Saskatchewan College of Nursing Health Sciences, E-4220, 104 Clinic Place, Saskatoon, S7N 5E5, SK, Canada.,Present address: School of Nursing, University of British Columbia, Vancouver, Canada
| | - Anton Saarimaki
- Ottawa Hospital Research Institute & University of Ottawa, 501 Smyth Road, Box 711, Ottawa, ON, K2G 0Y1, Canada
| | - Margaret L Lawson
- Family Decision Services, CHEO Research Institute, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, K1H 8L1, ON, Canada.
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Fraenkel L, Matzko CK, Webb DE, Oppermann B, Charpentier P, Peters E, Reyna V, Newman ED. Use of Decision Support for Improved Knowledge, Values Clarification, and Informed Choice in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016. [PMID: 26195173 DOI: 10.1002/acr.22659] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine the potential value of a theory-based, interactive decision support tool in clinical practice for patients with rheumatoid arthritis who are candidates for biologic agents. METHODS We conducted an 8-week, 2-arm, parallel, single-blind pilot trial in which candidates for treatment escalation with a biologic agent were randomized to receive either a link to a web-based tool or usual care. Outcomes included changes in objective knowledge, subjective knowledge, values clarification, and satisfaction with risk communication as well as the proportion of subjects defined as making an informed choice to escalate care at 2 weeks. RESULTS A total of 125 subjects were randomized. Significant between-group differences at 2 weeks favoring the intervention group were seen for changes in objective knowledge, subjective knowledge, and values clarification. No significant between-group differences were found in subjects' satisfaction with risk communication. Among those deciding to escalate care, a greater percentage met the criteria for an informed choice at 2 weeks in the intervention group compared to the control group (32% versus 13%; P = 0.02). Improvements in subjective knowledge and values clarification persisted at 8 weeks. There were no between-group differences in objective knowledge at 8 weeks. CONCLUSION In this study, use of a decision support tool at the time of decision-making resulted in improved objective and subjective knowledge, as well as values clarity, compared to usual care. Not all improvements were sustained, emphasizing the need to offer educational support should additional escalation of care be required over the course of the illness.
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Affiliation(s)
| | | | - Debra E Webb
- Geisinger Medical Center, Danville, Pennsylvania
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Downing J, Powell RA, Marston J, Huwa C, Chandra L, Garchakova A, Harding R. Children's palliative care in low- and middle-income countries. Arch Dis Child 2016; 101:85-90. [PMID: 26369576 DOI: 10.1136/archdischild-2015-308307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/27/2015] [Indexed: 11/03/2022]
Abstract
One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.
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Affiliation(s)
- Julia Downing
- International Children's Palliative Care Network, London, UK Makerere University, Kampala, Uganda
| | | | - Joan Marston
- International Children's Palliative Care Network, Bloemfontein, South Africa
| | - Cornelius Huwa
- Palliative Care Support Trust, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | | | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Feenstra B, Lawson ML, Harrison D, Boland L, Stacey D. Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study. BMC Med Inform Decis Mak 2015; 15:5. [PMID: 25889602 PMCID: PMC4326318 DOI: 10.1186/s12911-014-0126-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections). METHODS Pre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children's hospital. Parent-child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention. RESULTS Of 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent-child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making. CONCLUSION Decision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.
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Affiliation(s)
- Bryan Feenstra
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Laura Boland
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Knapp C, Sberna-Hinojosa M, Baron-Lee J, Curtis C, Huang IC. Does decisional conflict differ across race and ethnicity groups? A study of parents whose children have a life-threatening illness. J Palliat Med 2014; 17:559-67. [PMID: 24720434 DOI: 10.1089/jpm.2013.0604] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Children with life-threatening illnesses and their families may face a myriad of medical decisions in their lifetimes. Oftentimes these complicated medical decisions cause disagreements among patients, families, and providers about what is the best course of action. Although no evidence exists, it is possible that conflict may affect subgroups of the population differently. This study aims to investigate how decisional conflict varies among racial and ethnic subgroups. SAMPLE Two hundred sixty-six surveys were completed with parents whose children have a life-threatening illness. All children lived in Florida and were enrolled in the Medicaid program. The Decisional Conflict Scale, overall and broken down into its five distinct subscales, was used to assess parental decision-making. Descriptive, bivariate, and multivariate analyses were conducted. Subgroup analyses were conducted on Latino respondents. RESULTS Our bivariate results suggest that minority parents report less Effective Decision Making (p<0.05) and report less Support in Decision Making (p<0.05) compared to white, non-Hispanic parents. For the subgroup analysis, we found that those who identify as Mexican American and Central/South American report having greater Uncertainty in Choosing Options (p<0.05) and less Values Clarity (p<0.05) as compared to Puerto Rican or Cuban Americans. Results from the multivariate analyses suggest that those whose primary language is not English are associated with greater Uncertainty in Choosing Options (p<0.05). Values Clarity was lower for children who were diagnosed with their life-threatening condition at birth (p<0.05) as compared to children diagnosed at a later time. CONCLUSIONS Our study is the first to describe racial and ethnic differences in decisional conflict of parents of children with life-threatening illnesses. Significant differences exist by race, ethnicity, language spoken, and diagnosis time across several subdomains of decisional conflict. These differences are important to address when creating clinical care plans, engaging in shared decision-making, and creating interventions to alleviate decisional conflict.
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Affiliation(s)
- Caprice Knapp
- 1 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
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Kumar SP. Reporting of pediatric palliative care: a systematic review and quantitative analysis of research publications in palliative care journals. Indian J Palliat Care 2012; 17:202-9. [PMID: 22347775 PMCID: PMC3276817 DOI: 10.4103/0973-1075.92337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT Pediatric palliative care clinical practice depends upon an evidence-based decision-making process which in turn is based upon current research evidence. AIMS This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting characteristics of articles on pediatric palliative care. SETTINGS AND DESIGN This was a systematic review of palliative care journals. MATERIALS AND METHODS Twelve palliative care journals were searched for articles with "paediatric" or "children" in titles of the articles published from 2006 to 2010. The reporting rates of all journals were compared. The selected articles were categorized into practice, education, research, and administration, and subsequently grouped into original and review articles. The original articles were subgrouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles' category was further classified according to study designs. STATISTICAL ANALYSIS USED Descriptive analysis using frequencies and percentiles was done using SPSS for Windows, version 11.5. RESULTS The overall reporting rate among all journals was 2.66% (97/3634), and Journal of Hospice and Palliative Nursing (JHPN) had the highest reporting rate of 12.5% (1/8), followed by Journal of Social Work in End-of-Life and Palliative Care (JSWELPC) with a rate of 7.5% (5/66), and Journal of Palliative Care (JPC) with a rate of 5.33% (11/206). CONCLUSIONS The overall reporting rate for pediatric palliative care articles in palliative care journals was very low and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for pediatric palliative care.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Knapp C, Madden V, Wang H, Sloyer P, Shenkman E. Internet use and eHealth literacy of low-income parents whose children have special health care needs. J Med Internet Res 2011; 13:e75. [PMID: 21960017 PMCID: PMC3222184 DOI: 10.2196/jmir.1697] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 06/14/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Internet has revolutionized the way in which many Americans search for health care information. Unfortunately, being able to use the Internet for this purpose is predicated on having access to the Internet and being able to understand and comprehend online health information. This is especially important for parents of children with special health care needs who are forced to make many medical decisions throughout the lives of their children. Yet, no information is available about this vulnerable group. OBJECTIVE For parents of children with special health care needs we sought to (1) describe their Internet access and use, (2) determine which child and household factors were associated with Internet use, (3) describe eHealth literacy of Internet users, and (4) determine which child and household factors were associated with greater eHealth literacy. METHODS This was a cross-sectional telephone survey of 2371 parents whose children with special health care needs were enrolled in Florida's Medicaid and State Children's Health Insurance Plan (SCHIP) programs (4072 parents were approached). To be enrolled in the program, families must have incomes that are less than or equal to 200% of the federal poverty level. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy. Descriptive and multivariate analyses were conducted to address the study objectives. RESULTS The survey response rate was 58.2%. Participating parents were mainly female (2154/2371, 91%), white non-Hispanic (915/2371, 39%), English speaking (1827/2371, 77%), high school graduates (721/2371, 30%), married (1252/2371, 53%), and living in a two-parent household (1212/2371, 51%). Additionally, 82% of parents (1945/2371) in the sample reported that they used the Internet, and 49% of those parents used it daily (1158/2371). Almost three-quarters of Internet users had access to the Internet at home while about one-half had access at work. Parents who were African American, non-English speaking, older, and not college graduates were less likely to use the Internet than their referent groups (P < .001). About 74% of Internet users (1448/1945) reported that they knew how to find health information for their children. However, only about one-half (1030/1945) reported that they can tell high quality from low quality resources online or that they feel confident in using information accessed online to make health decisions. Multivariate regression results consistently showed that being a non-English speaker, having less than a high school education, and being older were all significantly associated with lower eHealth literacy (all P < .001). CONCLUSION Low-income parents of children with special health care needs have access to and use the Internet as a source of information about their children's health. However, some parents are unable to distinguish between high and low quality information and are not confident in using the Internet. This information is timely because as the pressure to use the Internet to empower consumers and exchange information increases, issues related to access and disparities must be better understood.
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Affiliation(s)
- Caprice Knapp
- University of Florida, Department of Health Outcomes and Policy, Gainesville, FL 32610, USA.
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Knapp C, Madden V, Marcu M, Wang H, Curtis C, Sloyer P, Shenkman E. Information seeking behaviors of parents whose children have life-threatening illnesses. Pediatr Blood Cancer 2011; 56:805-11. [PMID: 21370415 DOI: 10.1002/pbc.22674] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/05/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVES For children with life-threatening illnesses we sought to (1) understand the associations between parental characteristics and preferred health information sources, and (2) assess the e-health literacy of Internet-users. STUDY DESIGN Cross-sectional, telephone survey of 129 parents whose children are in a pediatric palliative care program in Florida. RESULTS Four out of five parents report that they use the Internet, and 64% of Internet-users use it daily. Parents who never use the Internet, versus parents who do use the Internet, are predominately Hispanic (50%) and have less than a high school education (64%) (P ≤ 0.023). Internet-users have high levels of e-health literacy; however, they are not confident or are unsure about the quality of information on the Internet. Not having graduated from high school was associated with a decrease in e-health literacy and using the Internet as the primary information source (vs. doctor as primary source) was associated with an increase in e-health literacy. CONCLUSION Parents of children with life-threatening illnesses have access to and use the Internet as a source of information about their children's health. More information is needed to explore how electronic-based interventions could be used to impact information seeking of parents whose children are in pediatric palliative care programs.
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Affiliation(s)
- Caprice Knapp
- Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, Florida, USA.
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Knapp C, Madden V, Wang H, Curtis C, Sloyer P, Shenkman E. Factors affecting decisional conflict for parents with children enrolled in a paediatric palliative care programme. Int J Palliat Nurs 2010; 16:542-7. [DOI: 10.12968/ijpn.2010.16.11.80020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Caprice Knapp
- Department of Health Outcomes and Policy, University of Florida, USA
| | - Vanessa Madden
- Department of Health Outcomes and Policy, University of Florida, USA
| | - Hua Wang
- Department of Health Outcomes and Policy, University of Florida, USA
| | - Charlotte Curtis
- Florida Department of Health, Children’s Medical Services Division, USA
| | - Phyllis Sloyer
- Florida Department of Health, Children’s Medical Services Division, USA
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