Decisional Conflict and Patients' Need in Medical Decision Making

Tuesday, 13 July 2010

Chiu-Chung Lai, BS
Department of nursing, College of Medicine, National Taiwan University, Taipei, Taiwan

Learning Objective 1: The learner will be able to identify the contributed factors of decisional conflict in patients.

Learning Objective 2: The learner will be able to lead more trust, less uncertainty and decisional conflict efficiently in patients during treatment decision making.

Purpose: It’s an respected issue about patient’s involvement and role preference in medical decision making, especially in this decade. This systemic review aims to determine the contributed factors of decisional conflict in patients as shared decision making relationship among physicians and patients is known to be chosen commonly.
Searches were carried out through databases, including Medline, Pubmed and Cumulative Index to Nursing and Allied Health Literature(CINAHL) from 1966 to Sep. 2009. Keywords, decision making, decisional conflict, role preference and patient involvement, were used. Only articles published in English were included.
100 articles were identified with 10 of them clarified decisional conflict in patients with role preference of shared decision making . Other 51 of them are confirmed decisional conflict reduced and active role in treatment involvement improved with decision-aid. Mostly there are cross-sectional studies and some are RCT on decision-aid. Factors of decisional conflict are contributed by insufficient information for benefit, harm, alternatives, lack of knowledge and unclear treatment values. Even if they are informed before decision making, uncertainty still be experienced. Although medical knowledge is specialized increasingly and doctors try to overcome the competence gap between them and their patients, there is no consensus of patient need to make medical decision between them. This result is identical among several nations, mostly in USA and different ethnicities. However, there are fewer studies to be discussed on decision making and decisional conflict in patient in Asia. Over half of searched articles on decision-aid proved the gap could be narrowed down practically.
 In critically clinical complex situation to make medical decision, what patients desire is more involvement, not decision-making independently. More information-getting about treatment from health professionals or with decision aids instead of knowledge-informed only could lead more trust,  less uncertainty and decisional conflict efficiently.