Decisional Conflict in Surgical Patients

Abstract

We are now living in the era of shared decision making and informed consent where the decision to undergo surgery is no longer decided by the operating surgeon alone. This involves a degree of decisiveness on the part of the patient. Decisional conflict is defined as a state of uncertainty about the course of action to be taken by the patients. Decisional conflict scale is a 16-item validated psychometric scale that measures decisional conflict objectively. In this study, we aim to introduce the concept of a decisional conflict and document its prevalence in patients undergoing surgery in a tertiary care center. This was a prospective observational study carried out in a tertiary care center between September 2019 and March 2020. The decisional conflict scale data was collected from the patients in the ward before shifting them to the operating theater. The maximum score possible was 80 and the minimum was 16. The higher the score is, the lesser the conflict. We chose an arbitrary cut-off value of 75% which equated to a score of 60 on the scale. The modified Kuppuswamy scale was used to calculate the socioeconomic status of patients. We had a total of 227 patients enrolled in the study. In our study, it was noted that 169 (74.45%) patients did not have a decisional conflict while 58 (25.55%) had a decisional conflict. There was no significant difference between the two groups in terms of education, occupation, income, and socioeconomic status. On subgroup analysis, it was noted that patients had a maximum conflict in 2 questions: (1) information about the available choices and (2) the risks and complications of the surgery. Measuring decisional conflict in surgical patients is feasible. Decisional conflict cuts across groups irrespective of patient gender, education, occupation, income, and socioeconomic status.