Risk factors of decisional conflict among people living with chronic pain identified through a pan-Canadian survey

Making decisions about chronic pain care is often challenging due to uncertainties, leading to decisional conflict when individuals do not receive the support and information they need. Shared decision-making interventions can help meet these needs; however, their effectiveness is inconsistent in the context of chronic pain. This study aimed to identify the decisional needs influencing decisional conflict among adults with chronic pain in Canada, to guide the development of more comprehensive interventions. In this pan-Canadian online survey, we measured decisional conflict related to the most difficult decision using the Decisional Conflict Scale (≥ 37.5 indicating clinically significant conflict) and assessed decisional needs based on the Ottawa Decision Support Framework. Of the 1,649 participants, 1,373 reported a Decisional Conflict Scale score. The mean age was 52 (SD = 16.4), with half of respondents being men (49.5%) and pain duration ranging from 3 months to 59 years. One-third (33.7%) experienced clinically significant decisional conflict. Seventeen risk factors were identified, including difficulty understanding healthcare information (OR = 2.43) and lack of prior knowledge of available options (OR = 2.03), while role congruence in decision-making was associated with reduced conflict (OR = 0.57). Future SDM interventions could be enhanced by targeting multiple risk factors of decisional conflict.