Substitute decision-making: measuring individually mediated sources of uncertainty

Area of Science:

• Medical Decision Making
• Health Psychology
• Patient Decision Aids

Background:

• O'Connor's Decisional Conflict Scale assesses factors contributing to decisional uncertainty.
• These factors include perceived lack of information, social pressure, lack of support, and unclear personal values.
• The scale's utility in substitute decision-making contexts requires validation.

Purpose of the Study:

• To explore the appropriateness of O'Connor's Decisional Conflict Scale in the substitute decision-making context.
• To assess the consistency between quantitative scale scores and qualitative verbal reports.

Main Methods:

• A quantitative/qualitative hybrid approach was employed.
• Forty-nine mothers deciding on gastrostomy tube insertion for their children completed the Decisional Conflict Scale.
• Participants also provided verbal reports on factors contributing to their decision uncertainty.

Main Results:

• Significant differences were observed in verbal reports across high-, moderate-, and low-scoring subgroups for information, perceived pressure, social support, and perceived gains/losses.
• These findings indicate consistency between the scale's quantitative scores and participants' qualitative experiences.
• The hybrid approach demonstrated clinical utility in assessing factors influencing decision uncertainty.

Conclusions:

• O'Connor's Decisional Conflict Scale is appropriate for assessing decisional conflict in substitute decision-making.
• The hybrid quantitative/qualitative method provides valuable insights into individually mediated factors affecting decision uncertainty.
• This approach can inform therapeutic interventions for substitute decision-makers.