Decisional Conflict in Patients with Dupuytren's: a Cross-Sectional Study
Mélissa Roy, MDCM; Karen Okrainec, MD, MSc, FRCPC; Christine B Novak, PT, PhD; Herbert P von Schroeder, MD, MSc, FRCSC; David R Urbach, MD, MSc, FRCSC, FACS; Steven J McCabe, MD, MS
University of Toronto Toronto, ON, Canada
Introduction: Multiple management options are available for Dupuytren's patients and treatment selection is a shared decision making process based on expectations, preferences, severity of disease, impact on daily life, and other factors. Decisional conflict represents the uncertainty about the course of action to take. Measuring patients' uncertainty provides health care providers an indicator of effective, value sensitive, and informed decision making. Our primary objective was to quantify the level of decisional conflict in Dupuytren's patients making a treatment decision for their disease. Our secondary objective was to evaluate a possible association between health literacy and decisional conflict.
Methods: This cross-sectional study was performed at a tertiary care centre Hand Program. Only patients making a Dupuytren's treatment decision and fluent in English were eligible to enrol. The degree of decisional conflict was measured at the end of clinical encounters using a validated, fast, reliable, and sensitive to change 16-item scale called the Decisional Conflict Scale (DCS). The scale spans a value range between 0 and 100: 0 is defined as no uncertainty and complete confidence, and 100 is defined as uncertain and not confident at all in the decision made. Health literacy was measured with the Newest Vital Sign (NVS) upon enrolment.
Results: A total of 30 patients were eligible and accepted to participate to the study representing 23 men and 7 women of average age 65 who had been diagnosed with Dupuytren's for an average of 4.9 (range 0-29) years. Conservative treatment or observation was selected in 11 (36.7%) cases, collagenase injection in 10 (33.3%), needle aponeurotomy in 8 (26.7%), and open surgical release in 1 (3.3%). The mean overall decisional conflict score was of 11.1±12.1 (range 0-26) representing a highly variable value by individual. The subscales with the highest level of decisional conflict were the values clarity 16.9±19.0 and feeling informed 12.5±14.3, whereas the support one had the lowest average score (5.8±10.5). No significant difference was noted when comparing the decisional conflict of groups choosing observation (14.5±23.0) with others choosing one of the three other options (17.3±23.0; p=0.41). No significant difference in the limited health literacy (10.6±7.2) versus adequate health literacy groups (11.7±14.0; p=0.49) were noted either.
Conclusions: Patients making treatment decisions for their Dupuytren's disease experience widely different levels of decisional conflict. They feel well supported when making such decisions but may benefit from further information to make their decision and realize the factors they prioritize.
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