Format

Send to

Choose Destination
Med Decis Making. 2009 Jan-Feb;29(1):61-8. doi: 10.1177/0272989X08327067. Epub 2009 Feb 4.

Decisional conflict in patients and their physicians: a dyadic approach to shared decision making.

Author information

1
Research Center, Hopital Saint François d'Assise, Centre Hospitalier Universitaire de Quebec, Université Laval, 10 rue de l'Espinay, Québec, Canada.

Abstract

BACKGROUND:

Decisional conflict is defined as personal uncertainty about which course of action to take when choice among competing options involves risk, regret, or challenge to personal life values. It is influenced by inadequate knowledge, unclear values, inadequate support, and the perception that an ineffective decision has been made. Until recently, it has been studied at the individual level, which ignores the interpersonal system between patients and physicians.

OBJECTIVE:

To explore the effect of feeling uninformed, unclear values, inadequate support, and the perception that an ineffective decision has been made on one own's outcome (actor effect) and on the other person's outcome (partner effect).

METHODS:

After a clinical encounter, modifiable deficits and personal uncertainty were measured in physicians and patients using the Decisional Conflict Scale. Structural equation modeling was used to measure the parameters of the Actor-Partner Interdependence Model.

RESULTS:

A total of 112 dyads of physicians and patients were included in the analysis. For both patients and physicians, 2 actor effects, unclear values (P < 0:0001) and the perception that an ineffective decision has been made (P < 0:0001), were found to be positively correlated with personal uncertainty. One partner effect, feeling uninformed (P=0:03), was found to be negatively correlated with personal uncertainty.

CONCLUSIONS:

Personal uncertainty of patients and physicians is influenced not only by their respective deficits but also by the deficits of the other member of the dyad. Our results indicate that the more unclear the expression of their own values and the more they perceive that an ineffective choice had been made, the more both physicians and patients experience personal uncertainty. They also indicate that the less uninformed they feel, the more both physicians and patients experience personal uncertainty.

PMID:
19196706
DOI:
10.1177/0272989X08327067
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center