Adaptação transcultural e validação da Decisional Conflict Scale para utilização no Brasil

Objetivo: Realizar a adaptação transcultural e avaliação das propriedades psicométricas da Decisional Conflict Scale para o português do Brasil. Métodos: Estudo metodológico de adaptação transcultural. Seguiu cinco etapas: tradução, síntese, tradução reversa, avaliação por comitê de especialistas e validação com 190 estudantes de enfermagem. A validade de constructo foi verificada por meio da análise fatorial exploratória, adotando-se a estatística de Kaiser-Meyer-Olkin, e as análises Screeplot e Engevalues. Utilizado o Alpha de Cronbach para avaliar a confiabilidade interna das subescalas. Resultados: O Coeficiente de Validade de Conteúdo dos itens alcançou concordância de 0,79. A estatística de Kaiser-Meyer-Olkin com resultado de 0,91, adequados a próxima etapa. A análise Screeplot apresentou distribuição de dois fatores, confirmada pela análise Engevalues. Análise Fatorial Exploratória revelou duas subescalas: a primeira Decisão, Incerteza e Suporte e a segunda Informação e Clareza de Valores, com coeficientes de Alpha de Cronbach 0,88 e 0,89. Conclusão: A versão em português do Brasil da Decisional Conflict Scale, Escala de Conflito na Tomada de Decisão, apresentou duas subescalas com adequadas evidências de validade e confiabilidade possibilitando identificar os fatores que influenciam no conflito de decisão no processo saúde-doença.

Decisional conflict scale for elective thoracic surgery

Background The relationship between patients and physicians in medical decision-making has changed in recent times. Although patients understand essential medical information, the estimation of risk/benefit of planned treatments is a difficult decision-making process for them. The research of decisional conflict targeted decision at surgery has been rarely performed. We prospectively researched decisional conflict using a questionnaire survey for patients with elective thoracic surgery and retrospectively reviewed the quantified and subcategorized data to examine clinical factors related with the decisional conflict scale (DCS) and the quality of life (QOL).Methods For patients with thoracic surgery, self-administered questionnaire surveys regarding decisional conflict and QOL were conducted at three time points: the day before surgery, at discharge, and at 3 months after surgery. The questionnaire survey of DCS is composed of five categories (uncertainty, informed, values clarity, support, and effective decision making) that use a five-point Likert-type response. QOL was measured in the Japanese version of the M.D. Anderson Symptom Inventory.Results The questionnaire surveys were performed from April 2017 to March 2019. Eighty six patients were analyzed in this study. The total DCS scores did not differ among pre-surgery, post-surgery, and 3 months after surgery (21.8, 20.3, 19.2, respectively; P = 0.48). The effective decision subscores significantly decreased after surgery (19.2, 13.4, 13.7, p = 0.041). The pain scores at discharge were significantly higher in patients who underwent thoracotomy surgeries than VATS (6.5 vs. 4.0, p = 0.013). However, the DCS scores did not show any significant difference between the surgical approaches at discharge (thoracotomy: 12.5, VATS: 13.5, p = 0.86) and at 3 months after surgery (thoracotomy: 22.5, VATS: 12.5, p = 0.11). The effective decision subscores did not show significance to post-operative complications at post-surgery before discharge and at 3 months after surgery (p = 0.94 and p = 0.40). At 3 months after surgery, the most QOL scores were significantly related to the total scores of DCS.Conclusions Patient’s own experience of thoracic surgery and post-operative management may decrease patient dissatisfaction. The findings suggest that decisional support for patients to organize their concrete perioperative management would ameliorate their satisfaction.

Cross-cultural adaptation and psychometric assessment of the statement format Decisional Conflict Scale for Mandarin version

Background The statement format of the Decisional Conflict Scale (sf-DCS) is designed and widely used to assess patients’ state of uncertainty during health related decision making. As yet no Mandarin version of the sf-DCS has been produced. This study aims to produce the first Mandarin version of the sf-DCS and test its validity and reliability in mainland China. Methods The translation and cross-cultural adaptation of the original English version of the sf-DCS into Mandarin was carried out in accordance with previously published guidelines. The psychometric properties of sf-DCS were assessed in two hypothesized decision-making contexts through online surveys. Results In the online survey designed to test scale validity and reliability, 437 people responded to the influenza immunization survey and 238 responded to the breast cancer screening survey. The results confirm that the Mandarin version of sf-DCS has good criteria validity and the exploratory factor analysis suggested a fitted revised five factors model by removing three items. Respondents who were “unsure” about their decisions/intentions, had read less information, and reported lower self-perceived prior knowledge level scored higher on sf-DCS. The Cronbach’s alpha for the sf-DCS total score was 0.963 and that for each subscale ranged from 0.784 to 0.937 in both decision making contexts, and the test-retest correlation coefficient was 0.528. Conclusions The Mandarin version of sf-DCS has good criteria validity and its internal consistency is satisfactory. Our analysis suggests a refinement of the original sf-DCS’s factor structure is needed.

Decisional Conflict Scale Use over 20 Years: The Anniversary Review

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.

Decisional Conflict Scale Findings among Patients and Surrogates Making Health Decisions: Part II of an Anniversary Review

Background. We explored decisional conflict as measured with the 16-item Decisional Conflict Scale (DCS) and how it varies across clinical situations, decision types, and exposure to decision support interventions (DESIs). Methods. An exhaustive scoping review was conducted using backward citation searches and keyword searches. 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. Dyads independently screened titles/abstracts and full texts, and extracted data. We performed narrative syntheses and calculated average or median DCS scores. Results. We included 246 articles reporting on 253 studies. DCS scores ranged from 2.4 to 79.7 out of 100. Highest baseline DCS scores were for care planning (44.8 ± 8.9, median = 47.0) and treatment decisions (32.5 ± 12.6, median = 31.9), in contexts of primary care (40.6 ± 18.3), and geriatrics (39.8 ± 11.2). Baseline scores were high among decision makers who were ill (33.2 ± 14.1, median = 30.2) or making decisions for themselves (33.4 ± 13.8, median = 32.0). Total DCS scores <25 out of 100 were associated with implementing decisions. Without DESIs, DCS scores tended to increase shortly after decision making (>37.4). After DESI use, DCS scores decreased short-term but increased or remained the same long-term (>6 months). Conclusions. DCS scores were highest at baseline and decreased after decision making. DESIs decreased decisional conflict immediately after decision making. The largest improvements after DESIs were in decision makers who were ill or made decisions for themselves. Further meta-analyses are needed for decision type, contexts, and interventions to inform hypotheses about the expected effects of DESIs, the best timing for measurement, and interpretation of DCS scores.

Development of a “Patient Rights” Subscale to Measure Informed Decision-Making Within the Dyadic Decisional Conflict Scale for Obstetric Care

Background and Purpose: A modified Dyadic Decisional Conflict Scale (D-DCS) and new Patient Rights subscale to measure perceptions of informed decision-making regarding use of epidural analgesia during childbirth are tested. Methods: Thirty-five primiparous women and 52 providers from three hospitals tested the modified instrument. Cronbach’s α coefficient assessed reliability. Mokken scale, principal components, and correlation analyses assessed unidimensionality of subscales. Results: Internal reliability was demonstrated for the D-DCS-Patient (Cronbach’s α = 0.846) and D-DCS-Provider (α = 0.888). Further analyses suggest the Patient Rightssubscale has potential to make a unique contribution to the D-DCS. Conclusions: The modified D-DCS and Patient Rights subscale allow for a more comprehensive study of informed healthcare decision-making that includes legal and ethical elements, which may aid development of targeted interventions to improve decision-making.