User Manual - Decisional Conflict Scale
Contents
1. unsure 3 probably no 4 no TOTAL SCORE 16 items items 1 16 inclusive are a summed b divided by 16 and c multiplied by 25 Scores range from 0 no decisional conflict to 100 extremely high decisional conflict UNCERTAINTY SUBSCORE 3 items 10 11 12 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely certain about best choice to 100 feels extremely uncertain about best choice INFORMED SUBSCORE 3 items 1 2 3 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely informed to 100 feels extremely uninformed VALUES CLARITY SUBSCORE 3 items 4 5 6 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely clear about personal values for benefits amp risks side effects to 100 feels extremely unclear about personal values SUPPORT SUBSCORE 3 items 7 8 9 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely supported in decision making to 100 feels extremely unsupported in decision making EFFECTIVE DECISION SUBSCORE 4 items 13 14 15 16 are a summed b divided by 4 and c multiplied by 25 Scores range from 0 good decision to 100 bad decision 4 2 3 Psychometric Properties We will have psychometric data on the scale s performance shortly 4 2 4 Applications using this Tool The scale is currently be2. Do you know the benefits and risks of each option O Risk benefit ratio Are you clear about which benefits and risks matter most to you O O Encouragement Do you have enough support and advice to make a choice O O The SURE Test O Connor and L gar 2008 Oui Non S r tes vous certain de ce qui constitue le meilleur choix pour vous O PE Est ce que vous connaissez les b n fices et risques de chacune des Utilit de l information T q O O options Risques b n fices Avez vous le sentiment de savoir ce qui est le plus important pour T oO balancer vous l gard des risques et b n fices Encouragement Avez vous suffisamment de soutien afin de faire votre choix O O The SURE Test O Connor and L gar 2008 4 4 2 Scoring and Interpretation Items are given a score value of 0 no 1 yes TOTAL SCORE UNCERTAINTY Can only be calculated if all items are answered The 4 items are summed Scores range from 0 extremely high decisional conflict to 4 no decisional conflict A score of lt 3 indicates decisional conflict AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 12 User Manual Decisional Conflict Scale 4 4 3 Psychometric Properties In English The scale has been tested with 1474 patients referred to watch condition specific video decision aids as part of their standard process of care Alpha
3. Unsure ao Tf B Considering the option you prefer please answer the following questions Yes Probably Unsure Probably No yes no 1 Do you know which options are available to you O O O O O 2 Do you know the benefits of each option O O O O O 3 Do you know the risks and side effects of each option O O O O O 4 Are you clear about which benefits matter most to you O O O 0O O 5 aE o clear about which risks and side effects matter most T E E O o aeaa e Oo o jojon 7 Do you have enough support from others to make a choice im O O O O 8 Are you choosing without pressure from others O g O g T 9 Do you have enough advice to make a choice o g O g T 10 Are you clear about the best choice for you T O O O O 11 Do you feel sure about what to choose gO g O O O 12 Is this decision easy for you to make O O O O T 13 Do you feel you have made an informed choice 0O O O O O 14 Does your decision show what is important to you O O O 0O O 15 Do you expect to stick with your decision O g O g E 16 Are you satisfied with your decision O g O O O Decisional Conflict Scale AM O Connor 1993 revised 2005 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid User Manual Decisional Conflict Scale 4 2 2 Scoring and Interpretation Items are given a score value of 0 yes 1 probably yes 2
4. h Encouragement Participant group myself information ratio French speaking pregnant women 123 0 47 0 32 0 59 0 07 English speaking treatment option 1474 0 46 0 33 0 45 0 49 patients Table 3 Item to total Pearson correlation coefficient results for the 2 participant groups 4 4 4 Applications using this Tool The tool has been used in 2 studies Further research should assess the performance of the SURE test with a more diverse group of patients 4 4 5 Other Languages This tool is available in English and in French 4 4 6 Availability You may use any of these scales at no cost without permission These tools are protected by copyright but are freely available for you to use as long as you cite the reference in any questionnaires or publications 4 4 7 Suggested Citations For the SURE tool L gar F Kearing S Clay K Gagnon S D Amours D Rousseau M O Connor AM Are you SURE Assessing patient decisional conflict with a 4 item screening test Can Fam Physician 2010 56 e308 314 For this User Manual O Connor AM User Manual Decisional Conflict Scale document on the Internet Ottawa Ottawa Hospital Research Institute 1993 updated 2010 cited YYYY MM DD 16 p Available from http decisionaid ohri ca docs develop User_Manuals UM_Decisional_Conflict pdf AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 14 Use
5. on tendency to blame doctor for bad outcomes if they forgo PSA testing for prostate cancer Urrutia M Campos S O Connor A Validaci n de una versi n en espa ol de la Escala de Conflicto Decisional Revita M dica de Chile 2008 136 1439 1447 LeBlanc A Kenny DA O Connor AM L gar F Decisional conflict in patients and their physicians a dyadic approach to shared decision making Med Decis Making 2009 Jan Feb 29 1 61 8 Epub 2009 Feb 4 L gar F Kearing S Clay K Gagnon S D Amours D Rousseau M O Connor AM Are you SURE Assessing patient decisional conflict with a 4 item screening test Can Fam Physician 2010 56 e308 314 Gagnon S Labrecque M Njoya M Rousseau F St Jacques S L gar F How much do family physicians involve pregnant women in decisions about prenatal screening for Down syndrome Prenat Diagn 2010 Feb 30 2 115 121 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 16
6. value based decision are more likely to stick with their choice and are more satisfied with the decision There is considerable empirical data to support the effects of decision supporting interventions on decisional conflict and its related modifiable constructs 1 3 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 2 User Manual Decisional Conflict Scale 3 Comparison of Versions of the Decisional Conflict Scale DCS There are 4 versions of the scale 1 for clinical practice see page 12 and 3 for research This table compares the research versions More details on these three versions are also provided on subsequent pages A STATEMENT FORMAT 16 items 5 response categories statements e Used in most studies to date e Many respondents like this version because it is personal e Those with limited response skills find it harder to respond to B QUESTION FORMAT 16 items 5 response categories questions e Easier response format e More precision than 3 item response format e Least tested now being tested with hundreds of patients C LOW LITERACY 10 items 3 response categories questions e Response format most useful for people with limited reading or response skills e Willing to forgo precision e Second most tested version RESPONSE FORMATS strongly agree agree neither agree or yes probably yes unsure pr
7. 3 4 Applications using this Tool The scale has been used in low literacy populations in Canada Ottawa USA New Hampshire Washington DC Texas and Chile 4 3 5 Availability You may use any of these scales at no cost without permission These tools are protected by copyright but are freely available for you to use provided you cite the reference in any questionnaires or publications 4 3 6 Suggested Citation O Connor AM User Manual Decisional Conflict Scale 10 item question format document on the Internet Ottawa Ottawa Hospital Research Institute 1993 updated 2010 cited YYYY MM DD 16 p Available from http decisionaid ohri ca docs develop User_Manuals UM_Decisional Conflict pdf AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 11 User Manual Decisional Conflict Scale 4 4 The SURE test version for clinical practice 4 items 2 response categories This version is recommended for use in everyday clinical practice Note We always precede the DCS with an option preference question which is not included in scoring See item A below 4 4 1 Scale A Which insert treatment screening option do you prefer Please check M one a L Option 1 b Option 2 c L Option 3 d L Unsure Yes No Sure of myself Do you feel SURE about the best choice for you O O Understanding information
8. 5 1 Definition The decisional conflict scale measures personal perceptions of a uncertainty in choosing options b modifiable factors contributing to uncertainty such as feeling uninformed unclear about personal values and unsupported in decision making and c effective decision making such as feeling the choice is informed values based likely to be implemented and expressing satisfaction with the choice AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 1 User Manual Decisional Conflict Scale 2 Conceptual Framework The conceptual framework guiding the scale development is reported in detail elsewhere 1 It was derived from the construct of decisional conflict developed by Janis and Mann 16 and refined as a diagnosis by the North American Nursing Diagnosis Association 17 Decisional conflict is a state of uncertainty about a course of action Such uncertainty is more likely when a person is confronted with decisions involving risk or uncertainty of outcomes when high stakes choices with significant potential gains and losses are entertained when there is a need to make value tradeoffs in selecting a course of action or when anticipated regret over the positive aspects of rejected options is probable The main behavioural manifestations of decisional conflict include verbalized uncertainty about choices verbalization of the undesired consequences of alt
9. GA Elmslie T Jolly E Hollingworth G McPherson R Drake E Hopman W Mackenzie T Randomized Trial of a Portable Self administered Decision Aid for Postmenopausal Women Considering Long term Preventive Hormone Therapy Medical Decision Making 1998 18 295 303 USED TRADITIONAL DCS Laupacis A O Connor AM Drake ER Rubens FD Robblee JA Grant FC Wells PS A decision aid for autologous pre donation in cardiac surgery a randomized trial Patient Education and Counselling in press USED TRADITIONAL DCS Man Son Hing M Laupacis A O Connor AM Biggs J Drake E Yetisir E Hart RG A Patient Decision Aid Regarding Antithrombotic Therapy for Stroke Prevention in Atrial Fibrillation A Randomized Controlled Trial JAMA 1999 282 737 743 USED TRADITIONAL DCS Dodin S Legare F Daudelin G Tetroe J O Connor AM Prise de d cision en mati re d hormonoth rapie de replacement Essai clinique randomise Canadian Family Physician 2001 47 1586 1593 USED FRENCH TRADITIONAL DCS Feldman Stewart D Brundage MD Manen LV A decision aid for men with early stage prostate cancer theoretical basis and a test by surrogate patients Health Expectations 2001 4 221 234 USED TRADITIONAL DCS Siminoff LA Ravdin P Colabianchi N Saunders Sturm CM Doctor patient communication patterns in breast cancer adjuvant therapy discussions Health Expectations 2000 3 26 36 USED TRADITIONAL DCS Morgan MWA randomized trial of the ischemic heart di
10. User Manual Decisional Conflict Scale Table of Contents dhs STII OM n ga en tocas E E th iu ea oben e E A a e E va dtee cea uk Ava nara l 2 Concept al FraneWotk i aniseni ana a a aa aa a aieeaa 2 3 Comparison of Versions of the Decisional Conflict Scale DCS Table cece eee ceeeeseeeteeeneees 3 4 Versions of the Decisional Conflict Scale DCS 4 1 Traditional DCS Statement format 16 item 5 response Categories ccceesceeeeeeeeetseeeeeees 4 Sample Tool Scoring and Interpretation Psychometric Properties Applications Using this Tool Other Languages Availability Suggested Citation 4 2 Question Format DCS 16 item 5 response Categories cecceeceeeseceeseeeseeceseceeeeeeeenseeesaeenes 7 Sample Tool Scoring and Interpretation Psychometric Properties Applications Using this Tool Other Languages Availability Suggested Citation 4 3 Question Format DCS 10 item 3 response Categories cccceesceeseceesceesceceeeceeeeeeeenaeecaeenes 9 Sample Tool Scoring and Interpretation Psychometric Properties Applications Using this Tool Other Languages Availability Suggested Citation 4 4 SURE tool version for clinical practice 4 items 2 response categories 2 0 ccceeeeeseetteeeteeees 12 Sample Tool Scoring and Interpretation Psychometric Properties Applications Using this Tool Other Languages Availability Suggested Citation J Annotated Referentes iaoe e a a o ae ae a mance gists win Nae eI PE AE 1
11. cede the DCS with an option preference question which is not included in scoring See item A below 4 1 1 Scale My difficulty in making this choice A Which insert treatment screening option do you prefer Please check M one C Option 1 L Option 2 C Option 3 Unsure B Considering the option you prefer please answer the following questions Strongly Agree Neither Disagree Strongly Agree Agree Disagree Or Disagree 0 1 2 3 4 1 know which options are available to me O O O 0 0 2 I know the benefits of each option O O O O O 3 I know the risks and side effects of each option O O O O 0 4 Iam clear about which benefits matter most to me O O O A ie 5 Iam clear about which risks and side effects matter most O O O O O 6 ea a soe a important to me the benefits o o T o o 7 Ihave enough support from others to make a choice Ol Ol oO oO 8 Iam choosing without pressure from others Ol o go o o 9 Ihave enough advice to make a choice Oo Ol oO oO oO 10 I am clear about the best choice for me O 0O O O O 11 I feel sure about what to choose E E O 0O O 12 This decision is easy for me to make O O O 0O O 13 I feel I have made an informed choice O E O O O 14 My decision shows what is important to me O 0O 0O 0O O 15 I expect to stick with my decision O E O 0O 0O 16 I am satisfied with my decision O O O 0O O Decisional Con
12. ch options are available to you Do you know the benefits of each option Do you know the risks and side effects of each option Are you clear about which benefits matter most to you Are you clear about which risks and side effects matter most to you Do you have enough support from others to make a choice Are you choosing without pressure from others Do you have enough advice to make a choice SON 90 a ON ae Dg eet Are you clear about the best choice for you O O O O O O O O O O ey LP yy a ey et 0 0O OlO O O O O O O O 0 10 Do you feel sure about what to choose Decisional Conflict Scale AM O Connor 1993 revised 2005 4 3 2 Scoring and Interpretation Items are given a score value of 0 yes 2 unsure 4 no TOTAL SCORE 10 items items 1 10 inclusive are a summed b divided by 10 and c multiplied by 25 Scores range from 0 no decisional conflict to 100 extremely high decisional conflict UNCERTAINTY SUBSCORE 2 items 9 10 are a summed b divided by 2 and c multiplied by 25 Scores range from 0 feels extremely certain about best choice to 100 feels extremely uncertain about best choice AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 9 User Manual Decisional Conflict Scale INFORMED SUBSCORE 3 items 1 2 3 are a summed b
13. coefficient was 0 86 The scale is responsive to change from baseline time 1 to the time following use of a video decision aid T2 and counseling about options T3 22 In French The SURE test was completed by 123 French speaking pregnant women registered at family medicine clinics in Quebec City 23 SURE score N Proportion who had Proportion who had not made choices made choices 4 981 67 96 4 3 272 18 66 34 2 147 10 59 41 1 54 4 54 46 0 20 1 65 35 Table 1 the SURE scores of patients in the treatment option group N 1474 and the proportion of them who had not made treatment choices Reliability of the SURE The internal reliability of SURE was moderate Cronbach a was 0 54 in French speaking pregnant women and 0 65 in English speaking treatment option patients In the group of pregnant women removing 1 item ie support produced a higher value Cronbach a 0 61 In the group of treatment option patients all item to item correlations were positive and ranged from 0 46 to 0 71 Construct validation In the group of French speaking pregnant women the SURE score correlated negatively with the DCS score r 0 46 P lt 0001 In the English speaking treatment option group patients who had not made choices about treatment n 225 had lower mean SD SURE scores than those who had n 1249 2 6 1 0 vs 3 6 0 8 respectively P lt 0001 See table 1 A fac
14. decision making EFFECTIVE DECISION SUBSCORE 4 items 13 14 15 16 are a summed b divided by 4 and c multiplied by 25 Scores range from 0 good decision to 100 bad decision NOTE The Cochrane systematic review of trials of patient decision aids 3 uses this scoring method other papers may present scores ranging from 1 low decisional conflict to 5 high decisional conflict If the SCORE or SUBSCORE is reported as a percentage or on a 0 100 scale no conversion is required If the average SCORE or SUBSCORE is reported on the 1 5 scale then to convert these scores to the equivalent 0 100 scale a subtract 1 from the score b then multiply by 25 If the SCORE or SUBSCORE is reported as a sum of items that used the 1 5 scale then to convert these scores to the equivalent 0 100 scale a divide the score by the number of items summed b then subtract 1 c then multiple by 25 4 1 3 Psychometric Properties Reliability e test retest correlations and Cronback alpha coefficients exceed 0 78 Construct Validity e correlated to related constructs of knowledge regret and discontinuance e discriminates between known groups those who make and delay decisions effect size ES ranges 0 4 to 0 8 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 5 User Manual Decisional Conflict Scale Responsive to change e in before after studies of decision suppor
15. divided by 3 and c multiplied by 25 Scores range from 0 feels extremely informed to 100 feels extremely uninformed VALUES CLARITY SUBSCORE 2 items 4 5 are a summed b divided by 2 and c multiplied by 25 Scores range from 0 feels extremely clear about personal values for benefits amp risks side effects to 100 feels extremely unclear about personal values SUPPORT SUBSCORE 3 items 6 7 8 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely supported in decision making to 100 feels extremely unsupported in decision making 4 3 3 Psychometric Properties English The scale has been tested with 63 women considering breast cancer options Alpha coefficient was 0 86 The scale is responsive to change from baseline time 1 to the time following use of a video decision aid T2 and counseling about options T3 mm R2 B Ti R2 T3 Ti R T3 m R2 T3 m R T3 Knowledge Values Clarity Support Certainty Summary AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 10 User Manual Decisional Conflict Scale Spanish The low literacy version has been tested with Spanish speaking women in disadvantaged areas in Chile The alpha coefficient was 0 72 and the scale discriminated significantly between those who were a actively deliberating among options and b not contemplating options or had already made their choice 4
16. ernatives vacillation between choices and delayed decision making Minor manifestations include verbalized distress while attempting decision making self focusing physical signs of distress or tension and questioning personal values and beliefs while attempting to make a decision Although decisional conflict occurs as a consequence of the difficulty inherent in the type of decision being made several modifiable cognitive affective and social factors can exacerbate the perceived uncertainty Uncertainty is greater when a person 1 feels uninformed about the alternatives benefits and risks 2 is unclear about personal values 3 feels unsupported in making a choice or pressured to choose on course of action Decisional conflict can be lowered with decision supporting interventions Information about options benefits risks and side effects can make people feel more informed Values can be clarified using strategies such as describing outcomes in sufficient detail including physical emotional and social impacts to better judge their value and asking patients to rate the personal importance of outcomes People may feel more supported in decision making if they are guided or coached in the steps of deliberation and shared decision making As a consequence their uncertainty stemming from these modifiable factors may decline and they may feel they have made a better decision By better decision they may feel that they have made a more informed
17. flict Scale AM O Connor 1993 revised 2005 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 4 User Manual Decisional Conflict Scale 4 1 2 Scoring and interpretation Items are given a score value of 0 strongly agree 1 agree 2 neither agree nor disagree 3 disagree 4 strongly disagree TOTAL SCORE 16 items items 1 16 inclusive are a summed b divided by 16 and c multiplied by 25 Scores range from 0 no decisional conflict to 100 extremely high decisional conflict UNCERTAINTY SUBSCORE 3 items 10 11 12 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely certain about best choice to 100 feels extremely uncertain about best choice INFORMED SUBSCORE 3 items 1 2 3 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely informed to 100 feels extremely uninformed VALUES CLARITY SUBSCORE 3 items 4 5 6 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely clear about personal values for benefits amp risks side effects to 100 feels extremely unclear about personal values SUPPORT SUBSCORE 3 items 7 8 9 are a summed b divided by 3 and c multiplied by 25 Scores range from 0 feels extremely supported in decision making to 100 feels extremely unsupported in
18. ing tested in several clinical services with large scale populations in New Hampshire breast cancer back surgery hip and knee surgery PSA testing 4 2 5 Availability You may use any of these scales at no cost without permission These tools are protected by copyright but are freely available for you to use provided you cite the reference in any questionnaires or publications 4 2 6 Suggested Citation O Connor AM User Manual Decisional Conflict Scale 16 item question format document on the Internet Ottawa Ottawa Hospital Research Institute 1993 updated 2010 cited YYYY MM DD 16 p Available from http decisionaid ohri ca docs develop User_Manuals UM_Decisional_Conflict pdf AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 8 User Manual Decisional Conflict Scale 4 3 Question Format DCS 10 item 3 response categories This version is recommended for those with limited reading or response skills Note We always precede the DCS with an option preference question which is not included in scoring See item A below 4 3 1 Scale My difficulty in making this choice A Which insert treatment screening option do you prefer Please check M one C Option 1 LC Option 2 C Option 3 Unsure aor B Considering the option you prefer please answer the following questions zZ Yes Unsure O Do you know whi
19. merous decisions 4 1 5 Availability You may use any of these scales at no cost without permission These tools are protected by copyright but are freely available for you to use provided you cite the reference in any questionnaires or publications 4 1 6 Suggested Citations O Connor AM Validation of a decisional conflict scale Med Dec Making 1995 15 1 25 30 The classic psychometric paper O Connor AM User Manual Decisional Conflict Scale 16 item statement format document on the Internet Ottawa Ottawa Hospital Research Institute 1993 updated 2010 cited YYYY MM DD 16 p Available from http decisionaid ohri ca docs develop User_Manuals UM_Decisional_Conflict pdf AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 6 User Manual Decisional Conflict Scale 4 2 Question Format Decisional Conflict Scale DCS 16 item 5 response categories This version is being tested by the Foundation for Informed Medical Decision Making as part of a standardized suite of decision process quality and decision quality measures using IPDAS Collaboration Note We always precede the DCS with an option preference question which is not included in scoring See item A below 4 2 1 Scale My difficulty in making this choice A Which insert treatment screening option do you prefer Please check M one Option 1 C Option 2 LC Option 3 C
20. obably yes no unsure disagree disagree strongly disagree no no INFORMED SUBSCALE I know which options are available to me Do you know which options are available to you Do you know which options are available to you I know the benefits of each option Do you know the benefits of each option Do you know the benefits of each option I know the risks and side effects of each option Do you know the risks and side effects of each option Do you know the risks and side effects of each option VALUES CLARITY SUBSCALE I am clear about which benefits matter most to me Are you clear about which benefits matter most to you Are you clear about which benefits matter most to you I am clear about which risks and side effects matter most Are you clear about which risks and side effects matter most to you Are you clear about which risks and side effects matter most to you I am clear about which is more important to me the benefits or the risks and side effects Are you clear about which is more important to you the benefits or the risks and side effects SUPPORT SUBSCALE I have enough support from others to make a choice Do you have enough support from others to make a choice Do you have enough support from others to make a choice I am choosing without pressure from others Are you choosing without pressure from others Are you choosing without p
21. r Manual Decisional Conflict Scale 5 Annotated References l 10 11 12 13 14 O Connor AM Validation of a decisional conflict scale Med Dec Making 1995 15 1 25 30 The classic psychometric paper Brehaut JC O Connor AM Wood TJ Hack TF Siminoff L Gordon E Feldman Stewart D Validation of a decision regret scale Medical Decision Making 2003 23 000 000 Shows correlation between DCS and regret O Connor AM Stacey D Rover D Holmes Rovner M Tetroe J Llewellyn Thomas H Entwistle V Rostom A Fiset V Barry M Jones J The Cochrane Databases of Systematic Reviews The Cochrane Library Volume 1 2003 There are several studies that used DCS note the smaller effect size when a simpler decision aid is compared to decision aid than when decision aid compared to usual care O Connor AM Fiset V DeGrasse C Graham ID Evans W Stacey D Laupacis A Tugwell P Decision Aids for Patients Considering Options Affecting Cancer Outcomes Evidence of Efficacy and Policy Implications Journal of the National Cancer Institute Monographs No 25 1999 Several before after studies cited here O Connor AM Decisional conflict Specify Nursing diagnosis and intervention 3 ed 486 496 Construct defined in first 1989 and subsequent editions Patient Decision Aid Research Group url for accessing evaluation measure information http decisionaid ohri ca eval html O Connor AM Tugwell P Wells
22. ressure from others I have enough advice to make a choice Do you have enough advice to make a choice Do you have enough advice to make a choice UNCERTAINTY SUBSCALE I am clear about the best choice from me Are you clear about the best choice for you Are you clear about the best choice for you I feel sure about what to choose Do you feel sure about what to choose Do you feel sure about what to choose This decision is easy for me to make Is this decision easy for you to make EFFE CTIVE DECISION SUBSCALE I feel I have made an informed choice Do you feel you have made an informed choice My decision shows what is important to me Does your decision show what is important to you I expect to stick with my decision I am satisfied with my decision Do you expect to stick with your decision Are you satisfied with your decision AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 3 User Manual Decisional Conflict Scale 4 Versions of the Decisional Conflict Scale DCS 4 1 Traditional Decisional Conflict Scale DCS Statement Format 16 item 5 response categories This is our most tested version Many people like the personal response format However it is more difficult to respond to than questions in those with limited reading and response skills Note We always pre
23. sease shared decision making program an evaluation of a decision aid University of Toronto 1997 USED TRADITIONAL DCS Murray E Davis H Tai SS Coulter A Gray A Haines A Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care BMJ 2001 323 490 3 USED TRADITIONAL DCS AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 15 User Manual Decisional Conflict Scale 15 16 17 18 19 20 21 22 23 Murray E Davis H Tai SS Coulter A Gray A Haines A Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care BMJ 2001 323 493 6 USED TRADITIONAL DCS Janis IL Mann L Decision Making New York The Free Press 1977 Psychological basis for defining the construct North American Nursing Diagnosis Association 10th Conference on Classification of Nursing Diagnoses San Diego California 1992 Definition from a standard taxonomy of nursing problems Sun Qiao Predicting Downstream Effects of High Decisional Conflict Meta analyses of the Decisional Conflict Scale Unpublished MSc thesis University of Ottawa 2005 Demonstrates the predictive validity of the DCS on option knowledge decision delay discontinuance and regret Gattelari amp Ward J Med Screen 2004 11 165 169 Shows independent effect of decisional conflict
24. ting interventions effect size ranges from 0 4 to 1 2 for the total scale e discriminates between different decision supporting interventions o Informed subscale consistently discriminates ES 0 3 to 0 4 o Total score and other sub scores less consistent especially when decision supporting intervention compared to alternative intervention rather than to usual care controls total scale ES 0 2 to 0 3 uncertainty scale 0 06 to 0 3 unclear values ES 0 3 to 0 4 unsupported ES 0 0 to 0 3 quality of choice 0 2 to 0 3 Predictive validity Sun 18 found that for every unit increase in the DCS people were e 59 times more likely to change their mind e 23 times more likely to delay their decision e 5 times more likely to express decisional regret e 3 times more likely to fail a knowledge test on options Gattelari and Ward 19 found that for every unit increase in DCS patients were 19 more likely to blame their doctor for bad outcomes Decisional conflict was an independent predictor of blame separate from other predictors such as knowledge scores and age of the patient Meaningful differences e we usually base sample sizes on detecting an effect size of 0 30 to 0 40 e scores lower than 25 are associated with implementing decisions scores exceeding 37 5 are associated with decision delay or feeling unsure about implementation 4 1 4 Applications using this tool The scale has been used in more than 30 studies for nu
25. torial analysis of the SURE test in the group of pregnant women indicated that 2 factors accounted for 72 of the variance Three items ie knowledge value and certainty loaded under 1 factor The other item ie support loaded under the second factor In the treatment option group 1 factor accounted for 49 of the variance Yes Responses Sure of Understand Risk benefit Ecouragement Patient group and Conditions N myself information ratio French speaking pregnant women e Prenatal screening 123 87 98 94 98 English speaking treatment option patients Total N 1474 e Hip osteoarthritis 160 80 99 95 94 e Knee osteoarthritis 292 75 98 95 90 e Herniated disk 177 76 99 93 93 AM O Connor User Manual Decisional Conflict Scale 1993 updated 2010 Available from www ohri ca decisionaid 13 User Manual Decisional Conflict Scale Yes Responses Sure of Understand Risk benefit Feouravement Patient group and Conditions N myself information ratio e Spinal stenosis 295 71 95 90 84 e Chronic back pain 171 75 89 89 80 e Prostate cancer 204 59 96 90 77 e Breast cancer reconstruction 86 74 97 93 86 e Early stage breast cancer surgery 89 60 96 87 84 Table 2 Percentage of participants responding yes to each of the 4 item SURE questions by conditions Correlation with Total Sure of Understand Risk benefit i N
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