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Decisional Conflict in Patients and Their Physicians: A Dyadic Approach to Shared Decision Making

Research Center, Hopital SaintFrançois d'Assise, Centre Hospitalier Universitaire de Quebec, Université Laval, Québec, Canada

David A. Kenny, PhD

Department of Psychology, University of Connecticut, Storrs, CT

Annette M. O'Connor, PhD

Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada

France Légaré, MD, PhD

Faculty of Medicine, Université Laval, Québec, Canada, Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise, 10 rue de l'Espinay, Québec (Québec), Canada G1L3L5, France.Légaré@mfa.ulaval.ca

Background. Decisional conflict is defined as personal uncertainty about which course of action to take when choice among competing options involves risk, regret, or challenge to personal life values. It is influenced by inadequate knowledge, unclear values, inadequate support, and the perception that an ineffective decision has been made. Until recently, it has been studied at the individual level, which ignores the interpersonal system between patients and physicians. Objective. To explore the effect of feeling uninformed, unclear values, inadequate support, and the perception that an ineffective decision has been made on one own's outcome (actor effect) and on the other person's outcome (partner effect). Methods. After a clinical encounter, modifiable deficits and personal uncertainty were measured in physicians and patients using the Decisional Conflict Scale. Structural equation modeling was used to measure the parameters of the Actor-Partner Interdependence Model. Results. A total of 112 dyads of physicians and patients were included in the analysis. For both patients and physicians, 2 actor effects, unclear values (P < 0:0001) and the perception that an ineffective decision has been made (P < 0:0001), were found to be positively correlated with personal uncertainty. One partner effect, feeling uninformed (P=0:03), was found to be negatively correlated with personal uncertainty. Conclusions. Personal uncertainty of patients and physicians is influenced not only by their respective deficits but also by the deficits of the other member of the dyad. Our results indicate that the more unclear the expression of their own values and the more they perceive that an ineffective choice had been made, the more both physicians and patients experience personal uncertainty. They also indicate that the less uninformed they feel, the more both physicians and patients experience personal uncertainty.

Key Words: Key words: shared decision making • relationship-centered care • dyadic decision making • physician-patient relationship • decisional conflict • Actor-Partner Interdependence Model. (Med Decis Making 2009;29:61—68)

This version was published on January 1, 2009

Medical Decision Making, Vol. 29, No. 1, 61-68 (2009)
DOI: 10.1177/0272989X08327067


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