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Collart C, Craighead C, Yao M, Rose S, Chien EK, Frankel RM, Coleridge M, Hu B, Edmonds BT, Ranzini AC, Farrell RM. Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care. J Perinat Med 2024; 0:jpm-2023-0442. [PMID: 38669584 DOI: 10.1515/jpm-2023-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Decisional conflict and regret about prenatal genetic screening and diagnostic tests may have important consequences in the current pregnancy and for future reproductive decisions. Identifying mechanisms that reduce conflict associated with the decision to use or decline these options is necessary for optimal patient counseling. METHODS We conducted a cluster-randomized controlled trial of a shared decision-making tool (NEST) at the beginning of prenatal care. Enrolled patients completed follow-up surveys at the time of testing (QTT) and in the second-third trimester (QFF), including the Decision Conflict Scale (DCS). Total DCS scores were analyzed using a multivariate linear mixed-effect model. RESULTS Of the total number of participants (n=502) enrolled, 449 completed the QTT and QFF surveys. The mean age of participants was 31.6±3.8, with most parous at the time of study participation (n=321; 71.7 %). Both the NEST (the intervention) and control groups had lower median total DCS scores at QFF (NEST 13.3 [1.7, 25.0] vs. control 16.7 [1.7, 25.0]; p=0.24) compared to QTT (NEST 20.8 [5.0, 25.0] vs. control 18.3 [3.3, 26.7]; p=0.89). Participants exposed to NEST had lower decisional conflict at QFF compared to control (β -3.889; [CI -7.341, -0.437]; p=0.027). CONCLUSIONS Using a shared decision-making tool at the start of prenatal care decreased decisional conflict regarding prenatal genetic testing. Such interventions have the potential to provide an important form of decision-making support for patients facing the unique type of complex and preference-based choices about the use of prenatal genetic tests.
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Affiliation(s)
- Christina Collart
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Caitlin Craighead
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah Rose
- Department of Biomedical Informatics and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward K Chien
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Marissa Coleridge
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Angela C Ranzini
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA
| | - Ruth M Farrell
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Bioethics, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
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Johnson A, McClurg AB, Baldino J, Das R, Carey ET. Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons. F S Rep 2024; 5:87-94. [PMID: 38524213 PMCID: PMC10958706 DOI: 10.1016/j.xfre.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To investigate the prevalence of decisional regret regarding preoperative fertility preservation choices after gender-affirming surgery or removal of reproductive organs. Design Cross-sectional. Setting University-based pratice. Patients A total of 57 survey respondents identifying as transgender men or gender nonbinary with a history of gender-affirming surgery or removal of reproductive organs between 2014 and 2023 with the University of North Carolina Minimally Invasive Gynecology division. Intervention Survey or questionnaire. Main Outcome Measures The prevalence and severity of decisional regret regarding preoperative fertility preservation choices were measured with the use of the validated decisional regret scale (DRS) (scored 0-100). Secondary outcomes included patient-reported barriers to pursuing reproductive endocrinology and infertility consultation and fertility preservation treatment. Results The survey response rate was 50.9% (57/112). "Mild" to "severe" decisional regret was reported by 38.6% (n = 22) of survey respondents, with DRS scores among all respondents ranging from 0-85. Higher median DRS scores were associated with patient-reported inadequacy of preoperative fertility counseling regarding implications of surgery on future fertility or family-building (0 vs. 50) and fertility preservation options (0 vs. 12.5). No desire for future fertility at the time of fertility counseling was the most frequent reason (68.4%) for declining a referral to reproductive endocrinology and infertility for additional fertility preservation discussion. Conclusions Decisional regret regarding preoperative fertility preservation choices is experienced among transgender men or gender nonbinary persons after gender-affirming surgery or the removal of reproductive organs. Preoperative, patient-centered fertility counseling and fertility preservation treatments should be provided to reduce the risk of future regret.
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Affiliation(s)
- Austin Johnson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Asha B. McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janine Baldino
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajeshree Das
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin T. Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kessler L, Illinsky D, Laudano M, Abraham NE. Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder? Neurourol Urodyn 2024; 43:22-30. [PMID: 37830272 DOI: 10.1002/nau.25286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB). MATERIALS AND METHODS This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant. RESULTS Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9) with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to 0.15, p = 0.02; DRS β coef: 1.48, 95% CI: 0.55-2.41, p < 0.01). CONCLUSIONS Patients who underwent SNM for refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperative complications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.
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Affiliation(s)
- Leia Kessler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Illinsky
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Laudano
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Liu AQ, McNeely BD, Prisman E, Hu A. Patient-Reported Decisional Regret After Operative Otolaryngology Procedures: A Scoping Review. Laryngoscope 2023. [PMID: 37947296 DOI: 10.1002/lary.31176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To review the published literature on decisional regret in adult patients undergoing operative otolaryngology procedures. The primary outcome was decisional regret scale (DRS) scores. DRS scores of 0 indicate no regret, 1-25 mild regret, and >25 moderate to strong/severe regret. DATA SOURCES A comprehensive librarian-designed strategy was used to search MEDLINE, Embase, and CINAHL from inception to September 2023. REVIEW METHODS Inclusion criteria consisted of English-language studies of adult patients who underwent operative otolaryngology treatments and reported DRS scores. Data was extracted by two independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Oxford Centre's Levels of Evidence were used for quality assessment. RESULTS In total, 6306 studies were screened by two independent reviewers; 13 studies were included after full-text analysis. Subspecialties comprised: Head and neck (10), endocrine (1), general (1), and rhinology (1). The DRS results of the included studies spanned a mean range of 10.1-23.9 or a median range of 0-20.0. There was a trend toward more decisional regret after large head and neck procedures or when patients underwent multiple treatment modalities. Depression, anxiety, and patient-reported quality of life measures were all correlated with decisional regret. Oxford Centre's Levels of Evidence ranged from 2 to 4. CONCLUSION This is the first comprehensive review of decisional regret in otolaryngology. The majority of patients had no or mild (DRS <25) decisional regret after otolaryngology treatments. Future research on pre-operative counseling and shared decision-making to further minimize patient decisional regret is warranted. LEVEL OF EVIDENCE N/A Laryngoscope, 2023.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brendan D McNeely
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Hu
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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McErlean G, Tapp C, Brice L, Pradhan A, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Decisional Regret in Long-Term Australian Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Cross-Sectional Survey. Clin Nurs Res 2023; 32:1134-1144. [PMID: 37329124 PMCID: PMC10504814 DOI: 10.1177/10547738231180337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an intensive but effective treatment for malignant and non-malignant diseases. However, long-term survival often comes at a cost, with survivors experiencing chronic morbidity and are at risk of relapse and secondary malignancy. This study aimed to describe decisional regret in a large cohort of Australian long-term allo-HSCT survivors. A cross-sectional survey was conducted with 441 adults in New South Wales, assessing quality of life (QoL), psychological, social, demographic, and clinical variables. Less than 10% of survivors expressed regret, with chronic graft-versus-host disease being the most important clinical factor. Psycho-socioeconomic factors such as depression, lower QoL scores, lower household income, higher treatment burden, and not resuming sex post-HSCT were also associated with regret. Findings highlight the need for valid informed consent and ongoing follow-up and support for allo-HSCT survivors dealing with life post-transplant. Nurses and healthcare professionals play a critical role in addressing decisional regret in these patients.
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Affiliation(s)
- Gemma McErlean
- University of Wollongong, Sydney, NSW, Australia
- New South Wales Agency for Clinical Innovation, Sydney, Australia
| | - Caley Tapp
- University of Queensland, Herston, Australia
- Queensland Centre for Mental Health Research, Wacol, Australia
| | - Lisa Brice
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Nicole Gilroy
- New South Wales Agency for Clinical Innovation, Sydney, Australia
- Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - John Moore
- St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - Louisa Brown
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Westmead Hospital, Sydney, NSW, Australia
| | | | - Christopher Ward
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | - Ian Kerridge
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
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Wen FH, Hsieh CH, Shen WC, Hou MM, Su PJ, Chou WC, Chen JS, Chang WC, Tang ST. Associations Between Surrogates' Decisional Regret Trajectories and Bereavement Outcomes. J Natl Compr Canc Netw 2023; 21:1141-1148.e2. [PMID: 37935096 DOI: 10.6004/jnccn.2023.7053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/23/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Family surrogates experience heterogeneous decisional regret and negative long-lasting postdecision impacts. Cross-sectional findings on the associations between decisional regret and surrogates' bereavement outcomes are conflicting and cannot illustrate the directional and dynamic evolution of these associations. In this study, we sought to longitudinally examine the associations between 4 previously identified decisional-regret trajectories and bereavement outcomes among family surrogates of terminally ill patients with cancer. PATIENTS AND METHODS This prospective, longitudinal, observational study included 377 family surrogates. Decisional regret was measured using the 5-item Decision Regret Scale, and 4 decisional regret trajectories were identified: resilient, delayed-recovery, late-emerging, and increasing-prolonged. Associations between bereavement outcomes (depressive symptoms, prolonged grief symptoms, and physical and mental health-related quality of life [HRQoL]) and decisional-regret trajectories were examined simultaneously by multivariate hierarchical linear modeling using the resilient trajectory as a reference. RESULTS Surrogates in the delayed-recovery, late-emerging, and increasing-prolonged trajectories experienced significantly higher symptoms of prolonged grief (β [95% CI], 1.815 [0.782 to 2.848]; 2.312 [0.834 to 3.790]; and 7.806 [2.681 to 12.931], respectively) and poorer physical HRQoL (-1.615 [-2.844 to -0.386]; -1.634 [-3.226 to -0.042]; and -4.749 [-9.380 to -0.118], respectively) compared with those in the resilient trajectory. Membership in the late-emerging and increasing-prolonged trajectories was associated with higher symptoms of depression (β [95% CI], 2.942 [1.045 to 4.839] and 8.766 [2.864 to 14.668], respectively), whereas only surrogates in the increasing-prolonged decisional-regret trajectory reported significantly worse mental HRQoL (-4.823 [-8.216 to -1.430]) than those in the resilient trajectory. CONCLUSIONS Surrogates who experienced delayed-recovery, unresolved, or late-emerging decisional regret may carry ceaseless doubt, guilt, or self-blame for patient suffering, leading to profound symptoms of prolonged grief, depressive symptoms, and worse HRQoL over their first 2 bereavement years.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, Republic of China
| | - Chia-Hsun Hsieh
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, Republic of China
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Jen-Shi Chen
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Wen-Cheng Chang
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, Republic of China
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, Republic of China
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, Republic of China
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, Republic of China
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Kantor J. This Month in JAAD International: October 2023: Shared decision-making in skin cancer treatment. J Am Acad Dermatol 2023; 89:674. [PMID: 37567481 DOI: 10.1016/j.jaad.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Jonathan Kantor
- Department of Dermatology, Center for Global Health, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Florida Center for Dermatology, St Augustine, Florida.
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Feifer D, Broden EG, Xiong N, Mazzola E, Baker JN, Wolfe J, Snaman JM. Mixed-methods analysis of decisional regret in parents following a child's death from cancer. Pediatr Blood Cancer 2023; 70:e30541. [PMID: 37414728 DOI: 10.1002/pbc.30541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Decisional regret is common in bereaved parents. We aimed to identify factors associated with and to explain patterns of parental decisional regret. METHODS We used a convergent mixed-methods design including quantitative items and free-text responses from a survey of parents 6-24 months from their child's death from cancer. Parents expressed whether they had regrets about decisions during the end of their child's life (Yes/No/I don't know) and elaborated with free text. Results of qualitative content analysis of free-text responses guided development and interpretation of quantitative multinomial models. RESULTS Parents (N = 123 surveys, N = 84 free text) primarily identified as White (84%), mothers (63%), and primary caregivers (69%) for their children. Forty-seven (38%) parents reported decisional regret, 61 (49%) indicated no regret, and 15 (12%) were unsure. Mothers (relative risk [RR]: 10.3, 95%CI: [1.3, 81.3], p = .03) and parents who perceived greater suffering at the end of their child's life (RR = 3.8, 95%CI: [1.2, 11.7], p = .02) were at increased risk of regret; qualitative evaluation revealed elements of self-blame and difficulty reconciling treatment choices with the ultimate outcome. Preparation for symptoms was associated with decreased risk of regret (RR = 0.1, 95%CI: [0, .3], p < .01) with qualitative reflections focused on balanced teamwork that alerted parents for what to expect and how to make meaningful final memories. CONCLUSIONS Though decisional regret is common among cancer-bereaved parents, mothers and those who perceive more suffering in their children may be at particular risk. Close collaboration between families and clinicians to prepare for symptoms and proactively attend to and minimize suffering may help alleviate decisional regret.
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Affiliation(s)
- Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joanne Wolfe
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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9
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Thompson CM, Voldal EC, Davidson GH, Sanchez SE, Ayoung-Chee P, Victory J, Guiden M, Bizzell B, Glaser J, Hults C, Price TP, Siparsky N, Ohe K, Mandell KA, DeUgarte DA, Kaji AH, Uribe L, Kao LS, Mueck KM, Farjah F, Self WH, Clark S, Drake FT, Fischkoff K, Minko E, Cuschieri J, Faine B, Skeete DA, Dhanani N, Liang MK, Krishnadasan A, Talan DA, Fannon E, Kessler LG, Comstock BA, Heagerty PJ, Monsell SE, Lawrence SO, Flum DR, Lavallee DC. Perception of Treatment Success and Impact on Function with Antibiotics or Appendectomy for Appendicitis: A Randomized Clinical Trial with an Observational Cohort. Ann Surg 2023; 277:886-893. [PMID: 35815898 PMCID: PMC10174100 DOI: 10.1097/sla.0000000000005458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days. SUMMARY BACKGROUND DATA The Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes. METHODS We focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized (RCT) and observational cohorts were pooled for exploration of baseline factors. The RCT cohort alone was used for comparison of treatments. Logistic regression was used to assess associations. RESULTS The pooled cohort contained 2062 participants; 1552 from the RCT. Overall, regret and dissatisfaction were low whereas problems with usual activities and prolonged missed work occurred more frequently. In the RCT, those assigned to antibiotics had more regret (Odd ratios (OR) 2.97, 95% Confidence intervals (CI) 2.05-4.31) and dissatisfaction (OR 1.98, 95%CI 1.25-3.12), and reported less missed work (OR 0.39, 95%CI 0.27-0.56). Factors associated with function outcomes included sociodemographic and clinical variables for both treatment arms. Fewer factors were associated with dissatisfaction and regret. CONCLUSIONS Overall, participants reported high satisfaction, low regret, and were frequently able to resume usual activities and return to work. When comparing treatments for appendicitis, no single measure defines success or failure for all people. The reported data may inform discussions regarding the most appropriate treatment for individuals. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02800785.
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Affiliation(s)
- Callie M Thompson
- Vanderbilt University Medical Center, Nashville, TN
- University of Utah, Salt Lake City, UT
| | | | | | | | - Patricia Ayoung-Chee
- Tisch Hospital NYU Langone Medical Center, New York, NY
- Grady Health, Morehouse School of Medicine, Atlanta, GA
| | - Jesse Victory
- Bellevue Hospital Center NYU School of Medicine, New York, NY
| | | | | | - Jacob Glaser
- Providence Regional Medical Center Everett, Everett, WA
| | | | | | | | | | | | | | - Amy H Kaji
- Harbor-UCLA Medical Center, Torrance, CA
| | | | - Lillian S Kao
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Krislynn M Mueck
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | | | | | - Sunday Clark
- Boston University Medical Center, Boston, MA
- Weill Cornell Medicine, New York, NY
| | | | | | | | - Joseph Cuschieri
- Harborview Medical Center, Seattle, WA
- University of California, San Francisco, San Francisco, CA
| | - Brett Faine
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Naila Dhanani
- University of Texas Lyndon B. Johnson General Hospital, Houston, TX
| | - Mike K Liang
- University of Texas Lyndon B. Johnson General Hospital, Houston, TX
- University of Houston, HCA Healthcare Kingwood, Kingwood, TX
| | | | - David A Talan
- Olive View-UCLA Medical Center, Sylmar, CA
- Ronald Reagan UCLA Medical Center, Westwood, CA
| | | | | | | | | | | | | | | | - Danielle C Lavallee
- University of Washington, Seattle, WA
- BC Academic Science Health Network, Vancouver, BC, Canada
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10
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Feifer D, Broden EG, Baker JN, Wolfe J, Snaman J. "It's Hard Not to Have Regrets:" Qualitative Analysis of Decisional Regret in Bereaved Parents. J Pain Symptom Manage 2023; 65:e399-e407. [PMID: 36641003 DOI: 10.1016/j.jpainsymman.2022.12.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023]
Abstract
CONTEXT Bereaved parents may have heightened risk for decisional regret; however, little is known about regret early in bereavement. OBJECTIVES We characterized decisional regrets endorsed by parents of children who died from cancer within the first two years of their bereavement. METHODS We analyzed responses from a cross-sectional, dual site study of parents six to 24 months from their child's death. Parents indicated whether they had regrets about decisions made at the end of their child's life (yes/no/I don't know) and elaborated with free text. We used content analysis to identify recurrent categories in parents' responses. RESULTS A total of 125 parents of 88 children completed the survey; 123 responded to the decisional regret item and 84 (63%) elaborated with free text. Forty-seven (38%) parents reported decisional regret(s), 61 (50%) indicated no regret(s), and 15 (12%) were unsure. Parental free-text responses related to five categories: treatments, including those pursued and/or not pursued (n = 57), decision-making processes (n = 35), relationships with their child and care team (n = 26), child suffering (n = 10), and end-of-life characteristics (n = 6). The relative frequency of categories was similar in parents with and without decisional regret, but self-blame was more common in responses from parents with decisional regret. CONCLUSION Many bereaved parents endorse decisional regret in early bereavement. Treatments and decision-making processes were most cited among parents both with and without regret. Identifying factors associated with heightened parental risk of decisional regret using longitudinal study is an important focus of future research.
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Affiliation(s)
- Deborah Feifer
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Justin N Baker
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care (D.F., E.B., J.W., J.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Quality of Life and Palliative Care, Department of Oncology (J.N.B.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Department of Pediatrics (J.W., J.S.), Boston Children's Hospital, Boston, Massachusetts, USA
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11
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Cheng L, Meiser B, Kirk E, Kennedy D, Barlow-Stewart K, Kaur R. Factors influencing patients' decision-making about preimplantation genetic testing for monogenic disorders. Hum Reprod 2022; 37:2599-2610. [PMID: 36006036 DOI: 10.1093/humrep/deac185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the roles of individual and interpersonal factors in couples' decision-making regarding preimplantation genetic testing for monogenic disorders (PGT-M)? SUMMARY ANSWER Couples' decision-making regarding PGT-M was associated with individual and interpersonal factors, that is the perceived consistency of information received, satisfaction with information, self-efficacy (individuals' beliefs in their ability to make decisions), actual knowledge about PGT-M and social support from the partner. WHAT IS KNOWN ALREADY Various factors have been shown to be associated with decision-making regarding PGT-M. However, PGT-M is experienced at an individual level, and to date, no studies have investigated the roles of the above-mentioned individual and interpersonal factors. STUDY DESIGN, SIZE, DURATION This is a cross-sectional study with 279 participants. Participants were recruited through IVFAustralia, Sydney Children's Hospital and support groups from May 2020 to November 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were women who had undergone or were considering PGT-M and their partners. Participants were recruited through IVFAustralia, Sydney Children's Hospital and support groups to complete online questionnaires. Decisional regret, decisional satisfaction and decisional conflict were measured as outcome variables. Multiple linear regressions were performed to examine the association between factors and outcome variables. Mann-Whitney U tests were performed to test the differences between participants who had undergone PGT-M and those who were considering PGT-M. MAIN RESULTS AND THE ROLE OF CHANCE For couples who had undergone PGT-M, decisional regret was significantly negatively associated with perceived consistency of information received (β = -0.26, P < 0.01), self-efficacy (β = -0.25, P < 0.01) and actual knowledge about PGT-M (β = -0.30, P < 0.001), while decisional satisfaction had positive association with satisfaction with information received (β = 0.37, P < 0.001) and self-efficacy (β = 0.24, P < 0.05). For couples who were considering PGT-M, decisional conflict was negatively associated with satisfaction with information received (β = -0.56, P < 0.001). For females who had undergone PGT-M, decisional regret was negatively associated with social support from the partner (β = -0.35, P < 0.05) in addition to perceived consistency of information received (β = -0.24, P < 0.05). In this group, decisional satisfaction was positively associated with women's satisfaction with the information received (β = 0.34, P < 0.01), social support from the partner (β = 0.26, P < 0.05) and self-efficacy (β = 0.25, P < 0.05). For females who were considering PGT-M, decisional conflict was negatively associated with satisfaction with the information received (β = -0.43, P < 0.01) and social support from the partner (β = -0.30, P < 0.05). This study also identified those aspects of PGT-M that couples felt most concerned about in relation to their decision-making, in particular safety issues such as short- or long-term health problems for the baby and potential harms to the embryos and the mother's health. The likelihood of getting pregnant and having a baby with a genetic condition being tested for were also important in couples' decision-making. LIMITATIONS, REASONS FOR CAUTION This study assessed the concerns of couples about having a baby with a variety of genetic conditions. However, condition-specific issues might not be covered. Furthermore, social support from the partner was assessed among females only. Male participants' perceived social support from their partner and the association between mutual support and decision-making were not assessed due to the absence of dyadic data. WIDER IMPLICATIONS OF THE FINDINGS Results highlight the importance of effective patient education on PGT-M and the need to provide high-quality and consistent information in the context of patient-centred care. Patients are likely to benefit from information that addresses their specific concerns in relation to PGT-M. From females' perspective, support from partners is essential, and partners should, therefore, be encouraged to participate in all stages of the decision-making process. Suggestions for future studies were made. STUDY FUNDING/COMPETING INTEREST(S) B.M. was funded through a Senior Research Fellowship Level B (ID 1078523) from the National Health and Medical Research Council of Australia. L.C. was supported by a University International Postgraduate Award under the Australian Government Research Training Program (RTP) scholarship. No other funding was received for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Lin Cheng
- Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Edwin Kirk
- Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Debra Kennedy
- Royal Hospital for Women, Sydney, NSW, Australia.,IVFAustralia, Sydney, NSW, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rajneesh Kaur
- Faculty of Medicine and Health Administration, The University of Sydney, Sydney, NSW, Australia
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12
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Associations of surrogates' death-preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life. Psychooncology 2022; 31:1502-1509. [PMID: 35793436 DOI: 10.1002/pon.5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Preparing family surrogates for patient death and end-of-life (EOL) decision making may reduce surrogate decisional conflict and regret. Preparedness for patient death involves cognitive and emotional preparedness. We assessed the associations of surrogates' death-preparedness states (that integrate both cognitive and emotional preparedness for patient death) with surrogates' decisional conflict and regret. METHODS Associations of 173 surrogates' death-preparedness states (no, cognitive-only, emotional-only, and sufficient preparedness states) with decisional conflict (measured by the Decision Conflict Scale) and heightened decisional regret (Decision Regret Scale scores >25) were evaluated using hierarchical linear modeling and hierarchical generalized linear modeling, respectively, during a longitudinal observational study at a medical center over cancer patients' last 6 months. RESULTS Surrogates reported high decisional conflict (mean [standard deviation] = 41.48 [6.05]), and 52.7% of assessments exceeded the threshold for heightened decisional regret. Surrogates in the cognitive-only preparedness state reported a significantly higher level of decisional conflict (β = 3.010 [95% CI = 1.124, 4.896]) than those in the sufficient preparedness state. Surrogates in the no (adjusted odds ratio [AOR] [95% CI] = 0.293 [0.113, 0.733]) and emotional-only (AOR [95% CI] = 0.359 [0.149, 0.866]) preparedness states were less likely to suffer heightened decisional regret than those in the sufficient preparedness state. CONCLUSIONS Surrogates' decisional conflict and heightened decisional regret are associated with their death-preparedness states. Improving emotional preparedness for the patient's death among surrogates in the cognitive-only preparedness state and meeting the specific needs of those in the no, emotional-only, and sufficient preparedness states are actionable high-quality EOL-care interventions that may lessen decisional conflict and decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, China
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13
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Gonçalves V. Decisional Regret in Female Oncofertility Decision Making-An Integrative Narrative Review. Cancers (Basel) 2021; 13:cancers13194735. [PMID: 34638222 PMCID: PMC8507540 DOI: 10.3390/cancers13194735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
It is well established that fertility is an important issue for young women with cancer at reproductive age, as many have not initiated or completed their parenthood goals when diagnosed. Because cancer treatments may impair fertility, women face fertility decisions that are often complex and surrounded by uncertainty. This may put patients at risk for psychological distress and the experience of regret regarding decisions made at diagnosis, which may be associated with a negative impact on women's QoL. This narrative review addresses current knowledge about decisional regret regarding fertility preservation decisions in adult female cancer patients at reproductive age. Electronic searches were conducted on Pubmed database for articles published in English from 1 January 2000 to 1 July 2021 that assessed decisional regret following fertility decisions in young women diagnosed at childbearing age. Of the 96 articles identified, nine provided information on decisional regret regarding fertility decisions. Studies reported that, overall, decisional regret regarding oncofertility decisions was low. Factors associated with the experience of decisional regret were patients' perceived quality and satisfaction with fertility counseling received, the decision to undergo fertility preservation, desire for children and decisional conflict. Health providers should be aware of the factors that are potentially modifiable and prone to improvement in order to reduce decisional regret. All efforts should be made to improve availability of and access to tailored high quality fertility counseling and fertility preservation. Given the growing evidence that decision aids (DAs) are effective in increasing knowledge and reducing decisional conflict and regret, their use in a routine and timely manner to complement fertility counseling is recommended.
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Affiliation(s)
- Vânia Gonçalves
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), Faculty of Economics, University of Coimbra, Av. Dias da Silva, 165, 3004-512 Coimbra, Portugal
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14
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Liang NSY, Adam S, Elliott AM, Siemens A, du Souich C, Friedman JM, Birch P. After genomic testing results: Parents' long-term views. J Genet Couns 2021; 31:82-95. [PMID: 34165210 DOI: 10.1002/jgc4.1454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022]
Abstract
Many parents are motivated to pursue genome-wide (exome or genome) sequencing to find a diagnosis for their child with a suspected but undiagnosed genetic condition. However, the impact of the genomic test extends beyond the provision of results and the so-called 'diagnostic odyssey'. Our goal was to quantify post-test decisional regret and characterize long-term, post-test experiences and unmet needs of the parents of children with suspected genetic diseases after they had received the results of genome-wide sequencing. Study participants were parents of children who underwent trio genome-wide sequencing as part of the CAUSES research study at Children's & Women's Health Centre of British Columbia. About half of the participants received a definite or likely genetic diagnosis after clinical interpretation of the genome-wide sequencing results. Parents who participated in the current study (n = 121) completed the Decisional Regret Scale four weeks after receiving results. A subset of these parents (n = 32) had semi-structured interviews a median of 7 months (range 3-20 months) after results disclosure and post-test genetic counseling. Most parents expressed either no regret or mild regret about having undergone genome-wide sequencing on both the Decisional Regret Scale and in the interviews. Parents whose children did not receive a genetic diagnosis were slightly more likely to have decisional regret on this quantitative scale. Analysis of transcribed interviews revealed the following major themes: (a) a lack of decisional conflict around having the testing; (b) a lack of decisional regret post-testing; (c) expressions of both relief and continued uncertainty around the meaning of a genetic diagnosis; (d) expression of initial disappointment and evolving interpretation surrounding a result yielding no genetic diagnosis; and (e) needing time to absorb the test results. Our results suggest that parents need time to absorb the testing results and that long-term post-test counseling, including acknowledging feelings of relief, loss, and disappointment, may help parents adapt to the genomic test results and assist families to anticipate and plan for the next steps in their child's medical trajectory, whether or not a diagnosis is found.
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Affiliation(s)
- Nicole Si Yan Liang
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Women's Health Research Institute, Vancouver, BC, Canada
| | - Angela Siemens
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christèle du Souich
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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15
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Jacobs JM, Marcus EL, Stessman J. Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to Life. J Am Med Dir Assoc 2021; 22:1242-1247. [PMID: 32907755 PMCID: PMC7474963 DOI: 10.1016/j.jamda.2020.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although prolonged mechanical ventilation (PMV) is increasingly common, little is known concerning patient symptom burden or attitudes toward PMV. This study aims to describe the mood, well-being, distressing symptoms, and attitudes toward prolonged ventilation among PMV patients treated either at home or long-term acute care (LTAC). DESIGN An observational study. SETTING AND PARTICIPANTS 62 communicative participants treated with PMV, aged ≥18 years, insurees of a single HMO, treated at home hospital or LTAC specializing in ventilation in Jerusalem. MEASURES Sociodemographic characteristics; chronic conditions; functional status; symptom burden measured by revised Edmonton Symptomatic Assessment System (r-ESAS); attitudes toward PVM. RESULTS Participants were aged 61.7 ± 20.7 years, commonly suffered progressive neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric Depression Scale identified depression among 38% of participants, and was less at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety (16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath (9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, and 15%, respectively. Only 1 patient had advance directives concerning ventilation prior to intubation, and when asked if they had to choose again today, 85% of patients would again opt for ventilation. CONCLUSIONS AND IMPLICATIONS Few PMV patients reported distressing symptoms, and 85% would choose ventilation if asked again. These findings might be useful in clinical practice to assist in decision making concerning prolonged ventilation.
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Affiliation(s)
- Jeremy M Jacobs
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Esther-Lee Marcus
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel
| | - Jochanan Stessman
- Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel; Department of Geriatrics and Geriatric Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Institute for Aging Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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16
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Ehrbar V, Germeyer A, Nawroth F, Dangel A, Findeklee S, Urech C, Rochlitz C, Stiller R, Tschudin S. Long-term effectiveness of an online decision aid for female cancer patients regarding fertility preservation: Knowledge, attitude, and decisional regret. Acta Obstet Gynecol Scand 2021; 100:1132-1139. [PMID: 33538329 DOI: 10.1111/aogs.14108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/14/2021] [Accepted: 01/30/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The decision, whether to undergo fertility preservation or not is highly demanding for cancer patients. Decision aids may act as an additional source of support. So far, only a limited number of decision aids regarding fertility preservation for female cancer patients exist and have been evaluated systematically. This paper presents the results of secondary analyses of the first randomized controlled trial evaluating an online decision aid for female cancer patients affected by different types of cancer. It focuses on fertility-related knowledge, attitude toward fertility preservation, and long-term effectiveness regarding decisional regret. MATERIAL AND METHODS Young female cancer patients between 18 and 40 years of age were recruited after fertility counseling with a reproductive specialist. They were assigned to either the control group (counseling only) or the intervention group (counseling followed by the additional use of the decision aid). Both groups had to complete a questionnaire after counseling as well as 1 and 12 months later, covering topics such as fertility-related knowledge, attitude towards fertility preservation, decisional conflict and regret. Recruitment was ongoing during 18 months in eight fertility centers located in Switzerland and Germany. RESULTS Mean age of participating women was 29.31 years (SD 4.57). Of the entire sample (n = 51) 53% were affected with breast cancer, 27.4% with lymphoma, and 19.6% with various other types of cancer. Knowledge regarding the most common fertility preservation methods was high and comparable in both groups. Positive attitude significantly exceeded negative attitude among all participants (p = 0.001). Although the altogether low scores for decisional regret were on a higher level in the control group (T2: mean = 19.00, SD = 13.24; T3: mean = 22.0, SD = 20.67) than in the intervention group (T2: mean = 14.12, SD = 11.07; T3: mean = 12.94, SD = 13.24), there were no statistically significant differences between and within both groups. There was a positive association between decisional conflict and decisional regret at T3 (p = 0.001, r = 0.510). CONCLUSIONS This decision aid was suitable as an additional source of knowledge and may positively impact decisional regret in the long term. Results suggest that the provision of an online decision aid as a complement to fertility counseling may facilitate decision-making.
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Affiliation(s)
- Verena Ehrbar
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Ariane Germeyer
- Department of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Heidelberg, Germany
| | - Frank Nawroth
- Center for Infertility, Prenatal Medicine, Endocrinology and Osteology, amedes experts, Hamburg, Germany
| | - Astrid Dangel
- Center for Infertility, Prenatal Medicine, Endocrinology and Osteology, amedes experts, Hamburg, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Corinne Urech
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Christoph Rochlitz
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ruth Stiller
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Sibil Tschudin
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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Xu RH, Zhou LM, Wang D. The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making. Front Psychiatry 2021; 12:657224. [PMID: 34220572 PMCID: PMC8242166 DOI: 10.3389/fpsyt.2021.657224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship. Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being. Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being. Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Center for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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18
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Xu RH, Zhou LM, Wong EL, Wang D, Chang JH. Psychometric Evaluation of the Chinese Version of the Decision Regret Scale. Front Psychol 2020; 11:583574. [PMID: 33424697 PMCID: PMC7793926 DOI: 10.3389/fpsyg.2020.583574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study was to evaluate the psychometric properties of the Chinese version of the decision regret scale (DRSc). Methods The data of 704 patients who completed the DRSc were used for the analyses. We evaluated the construct, convergent/discriminant, and known-group validity; internal consistency and test-retest reliability; and the item invariance of the DRSc. A receiver operating characteristic (ROC) curve was employed to confirm the optimal cutoff point of the scale. Results A confirmatory factor analysis (CFA) indicated that a one-factor model fits the data. The internal consistency (α = 0.74) and test-retest reliability [intraclass correlation coefficient (ICC) = 0.71] of the DRSc were acceptable. The DRSc demonstrated unidimensionality and invariance for use across the sexes. It was confirmed that an optimal cutoff point of 25 could discriminate between patients with high and low decisional regret during clinical practice. Conclusion The DRSc is a parsimonious instrument that can be used to measure the uncertainty inherent in medical decisions. It can be employed to provide knowledge, offer support, and elicit patient preferences in an attempt to promote shared decision-making.
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Affiliation(s)
- Richard Huan Xu
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Eliza Laiyi Wong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Jing Hui Chang
- School of Health Management, Southern Medical University, Guangzhou, China
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19
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Aldridge CE, Osiovich H, Hal Siden H, Elliott AM. Rapid genome-wide sequencing in a neonatal intensive care unit: A retrospective qualitative exploration of parental experiences. J Genet Couns 2020; 30:616-629. [PMID: 33131147 DOI: 10.1002/jgc4.1353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
Genome-wide sequencing (GWS) is increasingly being used in neonatal intensive care units. While studies have explored its clinical utility, little is known about parental experiences with this testing post-return of results. We conducted a qualitative study, using an interpretive description framework and thematic analysis, to gain further insight into parents' perceptions of the value and utility of GWS for their infant. We sought to explore whether parents' perceptions differ if their child received a diagnosis or not, and whether their child is living or deceased. Semi-structured, telephone interviews were conducted with parents of infants who had rapid exome sequencing while in the neonatal intensive care unit at BC Women's Hospital in Vancouver, Canada. Interviews addressed perceived benefits and harms of GWS and included an evaluation of decisional regret. Parents of 27 probands were approached and 14 (52%; 13 mothers and 1 father) participated in interviews. On average, 26 months had elapsed from the time of results to the interview. Six themes were identified. Firstly, parents had a positive regard for GWS. The results of GWS helped provide context for their child's admission to the NICU, and all parents experienced relief following receiving the results. A diagnosis by GWS enabled parents to picture the future, form connections with other parents, and coordinate their child's care. Lastly, some parents experienced discomfort with the concept of a genetic diagnosis, and interestingly felt lack of a genomic diagnosis indicated a reduced severity of their infant's condition. Decisional regret post-results was found to be low. Our results highlight how parents cope with the results of GWS and suggest that a genetic counselor can have an important role in helping families understand and adjust to these results in the neonatal intensive care unit.
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Affiliation(s)
- Caitlin E Aldridge
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Horacio Osiovich
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Women's Health Research Institute, Vancouver, BC, Canada
| | - Harold Hal Siden
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Women's Health Research Institute, Vancouver, BC, Canada
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Saeed F, Ladwig SA, Epstein RM, Monk RD, Duberstein PR. Dialysis Regret: Prevalence and Correlates. Clin J Am Soc Nephrol 2020; 15:957-963. [PMID: 32499230 PMCID: PMC7341783 DOI: 10.2215/cjn.13781119] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/09/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Although some patients regret the decision to start dialysis, modifiable factors associated with regret have rarely been studied. We aimed to identify factors associated with patients' regret to initiate dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A 41-item questionnaire was administered to adult patients receiving maintenance dialysis in seven dialysis units located in Cleveland, Ohio, and its suburbs. Of the 450 patients asked to participate in the study, 423 agreed and 397 provided data on decisional regret. We used multivariable logistic regression to identify predictors of regret, which was assessed using a single item, "Do you regret your decision to start dialysis?" We report adjusted odd ratios (ORs) and 95% confidence intervals (95% CIs) for the following candidate predictors: knowledge of CKD, attitudes toward CKD treatment, and preference for end-of-life care. RESULTS Eighty-two of 397 respondents (21%) reported decisional regret. There were no significant demographic correlates of regret. Regret was more common when patients reported choosing dialysis to please doctors or family members (OR, 2.34; 95% CI, 1.27 to 4.31; P<0.001). Patients who reported having a prognostic discussion about life expectancy with their doctors (OR, 0.42; 95% CI, 0.18 to 0.98; P=0.03) and those who had completed a living will (OR, 0.48; 95% CI, 0.25 to 0.95; P=0.03) were less likely to report regret with dialysis initiation. CONCLUSIONS Dialysis regret was common in this sample. Demographic factors (age, sex, marital status, race, or educational attainment) were not significantly associated with regret, but modifiable care processes were. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_06_09_CJN13781119.mp3.
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Affiliation(s)
- Fahad Saeed
- Department of Medicine, School of Public Health, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Susan A. Ladwig
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ronald M. Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Departments of Psychiatry and Family Medicine, and Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Rebeca D. Monk
- Department of Medicine, School of Public Health, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul R. Duberstein
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Goepfert RP, Fuller CD, Gunn GB, Hanna EY, Lewin JS, Zaveri JS, Hubbard RM, Barrow MP, Hutcheson KA. Symptom burden as a driver of decisional regret in long-term oropharyngeal carcinoma survivors. Head Neck 2017; 39:2151-2158. [PMID: 28736965 DOI: 10.1002/hed.24879] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/14/2017] [Accepted: 05/30/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize decisional regret and its association with symptom burden in a large cohort of oropharyngeal carcinoma (OPC) survivors. METHODS A cross-sectional survey was administered to 1729 OPC survivors. Survey items included a multisymptom inventory and a validated decisional regret inventory. Associations between regret and symptom scores were analyzed to determine and rank symptom drivers of decisional regret. RESULTS Nine hundred seventy-two patients responded reporting a low level of decisional regret overall, although 15.5% communicated "moderate to strong" regret. Overall symptom score and treatment group were statistically significant predictors of decisional regret. Relative to other symptoms, difficulty swallowing and feeling sad were the strongest drivers of decisional regret. CONCLUSION OPC survivors provide a robust description of their long-term outcomes with 15.5% expressing "moderate to high" regret that was significantly associated with late symptom burden and multimodality treatment. Difficulty swallowing was the strongest driver of decisional regret.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jhankruti S Zaveri
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel M Hubbard
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chan CHY, Lau HPB, Tam MYJ, Ng EHY. A longitudinal study investigating the role of decisional conflicts and regret and short-term psychological adjustment after IVF treatment failure. Hum Reprod 2016; 31:2772-2780. [PMID: 27664215 DOI: 10.1093/humrep/dew233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/10/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the relationship between decisional conflict, decisional regret and psychological well-being in women following unsuccessful IVF cycles? SUMMARY ANSWER The mediating effect of decisional regret on the relationship between decisional conflict and fertility-related quality of life (FRQOL) has been found to be moderated by the availability (versus absence) of frozen embryos after an unsuccessful IVF cycle. WHAT IS KNOWN ALREADY Infertility treatment is marked by its open-ended nature. Stresses in treatment decision-making could be aggravated by a culture which honours families through procreation. While studies have investigated treatment-related decision-making among infertile women, little is known about the mental health consequences of decisional conflict and decisional regret following an unsuccessful IVF cycle. STUDY DESIGN, SIZE, DURATION A study was conducted over a 3-month period with infertile women who had recently experienced a failed IVF cycle (T0). Decisional conflict when they decided on terminating or continuing treatment (T1) and decisional regret 3 months later (T2) were measured. Participants reported their levels of depression, anxiety and FRQOL at three time points. A total of 151 participants completed all time points (attrition rate: 39%). The average age of participants was 37.2 years, and they had had 1.1 cycles (range: 0-8) on average at the time of study intake. The duration of the study was 2 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were infertile women who were not pregnant following an IVF cycle recruited from a university-affiliated assisted reproduction centre. Following the notification of a negative pregnancy result, patients were invited to complete measures of FRQOL, depression and anxiety across three time points and decisional conflict and decisional regret at T1 and T2 respectively. MAIN RESULTS AND THE ROLE OF CHANCE Decisional regret partially mediated the effect of decisional conflict on overall and treatment-specific FRQOL (P < 0.05). The mediation by decisional regret was present only among participants who had no remaining frozen embryos after their unsuccessful IVF cycle (P < 0.05). LIMITATIONS, REASON FOR CAUTION Self-selection bias at recruitment remains a concern. WIDER IMPLICATIONS OF THE FINDINGS Our results show for the first time how mental health implications of decisional conflict may vary among patients with different clinical characteristics (i.e. availability of frozen embryos), despite their common experience of an unsuccessful IVF cycle. Healthcare professionals should be aware of the psychological ramifications of treatment decision-making difficulties, as well as individual differences in adjustment to unsuccessful treatment. STUDY FUNDING/COMPETING INTERESTS The study was funded by the Hong Kong University Grant Council-General Research Fund (HKU740613) and the authors have no conflicts of interest. TRIAL REGISTRATION NUMBER HKU Clinical Trials Registry (Trial registration number: HKUCTR-1680).
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Affiliation(s)
- Celia Hoi Yan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Hi Po Bobo Lau
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Michelle Yi Jun Tam
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Pokfulam, Hong Kong, China
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Aning JJ, Wassersug RJ, Goldenberg SL. Patient preference and the impact of decision-making aids on prostate cancer treatment choices and post-intervention regret. ACTA ACUST UNITED AC 2013; 19:S37-44. [PMID: 23355792 DOI: 10.3747/co.19.1287] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of prostate cancer survivors is rapidly growing in the Western world. As a result of better oncologic outcomes, more patients are living longer with the adverse effects of treatment, which can be both functional and psychological. Clinicians, in an era of shared decision-making, must not only cure the cancer, but also ensure that, after treatment, their patients experience the best quality of life and minimal post-treatment decisional regret. To participate in the decision-making process, men and their involved partners and family need to fully understand the relative benefits and harms of prostate cancer treatments.Patient preference studies indicate that men with prostate cancer are not well informed. Decision-making aids are a positive treatment adjunct both to convey information and to allow patients to explore their own beliefs and values during the decision-making process. The evidence suggests that decision-making aids better prepare patients for involvement in treatment decisions, but further studies are required to investigate the relationship between the use of decision-making aids and post-treatment decisional regret in prostate cancer.
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Affiliation(s)
- J J Aning
- The Vancouver Prostate Centre, Vancouver, BC
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