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The decision making control instrument to assess voluntary consent
Victoria A Miller1, Richard F Ittenbach2, Diana Harris3
1Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine (VAM)
Insights
Parents can now measure the perceived voluntariness of medical decisions for their children using the new Decision Making Control Instrument (DMCI). This validated tool assesses self-control, absence of control, and others' control in decision-making.
Area of Science:
- Medical Ethics
- Psychometrics
- Clinical Psychology
Background:
- Ensuring informed and voluntary consent is crucial for medical interventions and research participation.
- Parental decision-making for critically ill children requires careful consideration of voluntariness.
Purpose of the Study:
- To develop and validate an instrument measuring parents' perceived voluntariness when making decisions for their seriously ill children.
- Introduce the Decision Making Control Instrument (DMCI) as a novel tool for assessing perceived control in medical decision-making.
Main Methods:
- A 28-item experimental form of the DMCI was administered to 219 parents at a tertiary care children's hospital.
- Exploratory and confirmatory factor analyses were employed to refine the instrument.
- The study utilized statistical techniques to validate the construct and internal consistency of the DMCI.
Main Results:
- Factor analysis reduced the instrument to a 9-item scale with three dimensions: Self-Control, Absence of Control, and Others' Control.
- The 3-factor model demonstrated consistency with the collected data.
- The DMCI exhibited high internal consistency (0.83 overall, 0.68-0.87 for subscales) and construct validity, correlating with affect, trust, and decision self-efficacy measures.
Conclusions:
- The Decision Making Control Instrument (DMCI) is a reliable and valid tool for assessing perceived voluntariness in medical decision-making.
- The DMCI can enhance understanding of treatment and research decision voluntariness in pediatric healthcare settings.
- This instrument provides valuable insights into the psychological factors influencing parental consent for medical interventions.
Background:
The decision to participate in a research intervention or to undergo medical treatment should be both informed and voluntary.
Objective:
The aim of the present study was to develop an instrument to measure the perceived voluntariness of parents making decisions for their seriously ill children.
Methods:
A total of 219 parents completed questionnaires within 10 days of making such a decision at a large, urban tertiary care hospital for children. Parents were presented with an experimental form of the Decision Making Control Instrument (DMCI), a measure of the perception of voluntariness. Data obtained from the 28-item form were analyzed using a combination of both exploratory and confirmatory factor analytic techniques.
Results:
The 28 items were reduced to 9 items representing 3 oblique dimensions: Self-Control, Absence of Control, and Others' Control. The hypothesis that the 3-factor covariance structure of our model was consistent with that of the data was supported. Internal consistency for the scale as a whole was high (0.83); internal consistency for the subscales ranged from 0.68 to 0.87. DMCI scores were associated with measures of affect, trust, and decision self-efficacy, supporting the construct validity of the new instrument.
Conclusion:
The DMCI is an important new tool that can be used to inform our understanding of the voluntariness of treatment and research decisions in medical settings.
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