Substitute decision-making: measuring individually mediated sources of uncertainty

One aspect of O'Connor's Decisional Conflict Scale [O'Connor, A.M., Validation of a decisional conflict scale, Med. Decis. Making 15 (1995) 25-30] is the assessment of selected factors (perceived lack of information, undue social pressure, lack of support from others, and lack of clarity about personal values) that are believed to contribute to decisional uncertainty. This study explored the appropriateness of this uncertainty measure in the substitute decision-making context. Forty-nine mothers deciding on gastrostomy tube insertion for their children completed the scale, and also provided verbal reports about the contributory factors. For each of the four factors, relatively high-, moderate-, and low-scoring sub-groups were identified; then the associated verbal reports were examined for across-sub-group differences. Differences in verbal reports about information (chi 2 = 6.990, P = 0.0082), perceived pressure (chi 2 = 8.377, P = 0.0038), social support (chi 2 = 5.573, P = 0.0182), and perceived gains and losses (chi 2 = 3.85, P = 0.0499; chi 2 = 5.76, P = 0.0164) were observed, implying consistency between quantitative scores and verbal reports. This quantitative/qualitative hybrid approach may be clinically useful for assessing individually mediated factors contributing to decision uncertainty, and for evaluating therapeutic interventions in other substitute decision-making contexts.