134 | Chapter 5 Table 2: Decisional Conflict Scale and subscores at T1 and T2 Usual Care Intervention Median (range) T1 N=45 T1 N=46 adjusted MD + 95%CI P-value DCS total 73.44 (25.00 - 100) 35.94 (17.19-46.88) -32.3, -37.4; -26.1 <0.001 Uncertainty 75.00 (16.67 - 100) 41.67 (25-66.67) -25.9, -33.0; -18.8 <0.001 Informed 75.00 (25.00 - 100) 33.33 (8.33-83.33) -28.6, -36.9; -20.2 <0.001 Values clarity 75.00 (25.00 - 100) 33.33 (8.33-58.33) -30.7, -37.5; -23.1 <0.001 Support 75.00 (8.33 - 100) 33.33 (16.67-58.33) -36.9, -43.5; -28.1 <0.001 Effective decision 75.00 (6.25 - 100) 31.25 (12.5-50.00) -38.6, -44.4; -32.2 <0.001 Abbreviations: T1, directly after counseling; T2, six months after treatment; DCS, Decisional Conflict Scale; CSDC, Clinically Significant Decisional Conflict (DCS >25) MD, Mean Difference Knowledge was systematically better in all treatment subgroups, at both timepoints, after implementation of the PDA. TL questions had the lowest % correct, Radiotherapy (RT) questions had the highest % correct. (Table 3). Shared decision-making Patients’ Perceived Shared Decision Making (SDM) was significantly higher in the intervention arm (mean 78.16, SD 8.31)) compared to the usual care arm (mean 70.32, SD 16.11) (p=0.005) with an adjusted mean difference of 6.2 (95% CI 0.4;12.0, p=0.006, with both arms exhibiting relatively high levels. Six months post-treatment, perceived SDM level scores increased in both arms, with the intervention arm (mean 81.63, SD 10.39) remaining higher than the usual care arm (mean 71.88, SD 14.22, with an adjusted mean difference of 7.0 (95% CI -0.4; 14.4, p=0.0053). Physicians mean perceived SDM was 69.96 (SD 17.71), and no significant differences after introduction of the PDA (mean 68.21, SD 13.28). See appendix for B for all results. Control Preferences The majority of patients expressed a preference for collaborative decision-making, sharing responsibility with their treating physician, as indicated by statements 2, 3, and 4. This inclination was consistent in both study arms, with 76% (34/45) in the usual care arm and 87% (40/46) in the intervention arm (Table 4).
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