Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment

BackgroundBreast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions.Methods320 women aged 20–79 diagnosed with AJCC stage 0 – III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach’s alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation.ResultsFor overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of “Right for You” for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively.ConclusionsOur measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of information, time, and involvement. Future research is needed to establish norms for the measure as is further psychometric testing, particularly to examine how it is associated with outcomes such as quality of life, psychological coping and objective decision quality.

[1]  Angela Fagerlin,et al.  Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. , 2005, Health services research.

[2]  C. Charles,et al.  Women's perceptions of their treatment decision-making about breast cancer treatment. , 2008, Patient education and counseling.

[3]  P. Carroll.  Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study , 2003 .

[4]  A. O'Connor.  Validation of a Decisional Conflict Scale , 1995, Medical decision making : an international journal of the Society for Medical Decision Making.

[5]  J. Mancini,et al.  Cross-cultural validation of the Decisional Conflict Scale in a sample of French patients , 2006, Quality of Life Research.

[6]  P. Stalmeier,et al.  Concise evaluation of decision aids. , 2009, Patient education and counseling.

[7]  J. Mandelblatt,et al.  A qualitative study of factors affecting chemotherapy use in older women with breast cancer: barriers, promoters, and implications for intervention , 2006, Psycho-oncology.

[8]  Karthik Ghosh,et al.  Factors associated with surgical decision making in women with early-stage breast cancer: a literature review. , 2013, Journal of women's health.

[9]  Bernard T. Lee,et al.  Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction. , 2013, The Journal of surgical research.

[10]  Karen R. Sepucha,et al.  How Does Feeling Informed Relate to Being Informed? The DECISIONS Survey , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  Sarah M. Greene,et al.  Breast cancer anxiety's associations with responses to a chemoprevention decision aid. , 2013, Social science & medicine.

[12]  Karen R. Sepucha,et al.  Decision dissonance: evaluating an approach to measuring the quality of surgical decision making. , 2013, Joint Commission journal on quality and patient safety.

[13]  Glyn Elwyn,et al.  Shared decision making for treatment of cancer: challenges and opportunities. , 2014, Journal of oncology practice.

[14]  Karen Patricia Williams,et al.  Development of decision‐support intervention for Black women with breast cancer , 2010, Psycho-oncology.

[15]  D. Klingbiel,et al.  Predictors of satisfaction with treatment decision, decision-making preferences, and main treatment goals in patients with advanced cancer , 2013, Supportive Care in Cancer.

[16]  Karen R Sepucha,et al.  Impact of decision aids in a sustained implementation at a breast care center. , 2012, Patient education and counseling.

[17]  M. Holmes-Rovner,et al.  Patient Satisfaction with Health Care Decisions , 1996, Medical decision making : an international journal of the Society for Medical Decision Making.

[18]  Karen R. Sepucha,et al.  How to define and measure concordance between patients' preferences and medical treatments: A systematic review of approaches and recommendations for standardization. , 2010, Patient education and counseling.

[19]  P. Arbon,et al.  The experience of making treatment decisions for women with early stage breast cancer: a diagrammatic representation. , 2005, European journal of cancer care.

[20]  Glyn Elwyn,et al.  Deliberation before determination: the definition and evaluation of good decision making , 2009, Health expectations : an international journal of public participation in health care and health policy.

[21]  F. Gilliland,et al.  Patient satisfaction with treatment decisions for clinically localized prostate carcinoma. Results from the Prostate Cancer Outcomes Study , 2003, Cancer.

[22]  Trudy van der Weijden,et al.  Assessing the Quality of Decision Support Technologies Using the International Patient Decision Aid Standards instrument (IPDASi) , 2009, PloS one.

[23]  Sarah E Lillie,et al.  Surgeon-Level Variation in Patients’ Appraisals of Their Breast Cancer Treatment Experiences , 2012, Annals of Surgical Oncology.

[24]  E. Deci,et al.  The "What" and "Why" of Goal Pursuits: Human Needs and the Self-Determination of Behavior , 2000 .

[25]  Karen R. Sepucha,et al.  An approach to measuring the quality of breast cancer decisions. , 2007, Patient education and counseling.

[26]  Ken Resnicow,et al.  Toward systematic integration between self-determination theory and motivational interviewing as examples of top-down and bottom-up intervention development: autonomy or volition as a fundamental theoretical principle , 2012, International Journal of Behavioral Nutrition and Physical Activity.

[27]  Edward L. Deci,et al.  Intrinsic Motivation and Self-Determination in Human Behavior , 1975, Perspectives in Social Psychology.

[28]  M. Morrow,et al.  Patient satisfaction with treatment of breast cancer: does surgeon specialization matter? , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[29]  Karen R. Sepucha,et al.  Patients’ Knowledge about 9 Common Health Conditions: The DECISIONS Survey , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[30]  J. Blasko,et al.  Factors that predict treatment choice and satisfaction with the decision in men with localized prostate cancer. , 2006, Clinical genitourinary cancer.

[31]  K. Metcalfe,et al.  Decision Regret following Breast Reconstruction: The Role of Self-Efficacy and Satisfaction with Information in the Preoperative Period , 2013, Plastic and reconstructive surgery.

[32]  Karen R. Sepucha,et al.  Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery , 2012, BMC Medical Informatics and Decision Making.

[33]  Karen R. Sepucha,et al.  Informing and involving patients to improve the quality of medical decisions. , 2011, Health affairs.

[34]  P. Viens,et al.  Young breast cancer patients' involvement in treatment decisions: the major role played by decision‐making about surgery , 2013, Psycho-oncology.

[35]  Karen R. Sepucha,et al.  Toward the 'tipping point': decision aids and informed patient choice. , 2007, Health affairs.

[36]  Karen R. Sepucha,et al.  Decision making about surgery for early-stage breast cancer. , 2012, Journal of the American College of Surgeons.

[37]  Karen R. Sepucha,et al.  Establishing the effectiveness of patient decision aids: key constructs and measurement instruments , 2013, BMC Medical Informatics and Decision Making.

[38]  K. Sepucha,et al.  Do Patients and Providers Agree About the Most Important Facts and Goals for Breast Reconstruction Decisions? , 2010, Annals of plastic surgery.

[39]  M. Morrow,et al.  Factors associated with patient involvement in surgical treatment decision making for breast cancer. , 2007, Patient education and counseling.

[40]  P M Bossuyt,et al.  Decision support for patients with early-stage breast cancer: effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[41]  Rana F. Obeidat,et al.  Decision aids for surgical treatment of early stage breast cancer: a narrative review of the literature. , 2011, Patient education and counseling.

[42]  H. Kokufu.  Conflict accompanying the choice of initial treatment in breast cancer patients. , 2012, Japan journal of nursing science : JJNS.