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Difficult choices for young patients with cancer: the supportive role of decisional counseling

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Abstract

Purpose

The aim of patient decisional support interventions is to promote shared decision making. Many of these interventions are comprehensive of information and guidance. In this pilot study, we evaluate the effects of a decision-making support (decision counseling (DeCo)) on decision making, decisional conflict, and anxiety in cancer patients facing with values-based decisions on fertility and procreation or genetic testing and risk reduction options in oncology.

Methods

DeCo was proposed during the medical consultation. The following questionnaires were administered to 54 patients before the DeCo session and 1 week after it: stage of decision making (SDM), decisional conflict scale (DCS) and subscales (“uncertainty,” “informed,” ”clarity,” “support,” and “effective decision”), state-trait anxiety inventory. Decision Support Questionnaire and Usefulness of Decision Counseling were created ad hoc for this study. Multivariate logistic models and ANCOVA models were used to investigate the changes of SDM and DCS in association with DeCo.

Results

We found a significant improving in SDM with DeCo (P = 0.01) and a significant reduction in DCS with DeCo (P = 0.007) measured with the Decision Support Questionnaire. In particular, the DCS informed subscale showed a significant decrease in time (P = 0.002).

Conclusion

DeCo is useful to facilitate decision making and reduce decisional conflict. It plays a role in the perception of being informed while not directly providing clinical information. This model of decisional support intervention, in which information is provided only by the clinician and decisional support is focused on personal aspects that influence the decision, could improve shared decision making between patient and clinicians.

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Acknowledgments

Authors are grateful to Daniela Cerrato (donnamoderna.com) and Clara Varricchio, MD for their support and contribution in trial activation. Financial support for this study was provided in part by grant from the European Institute of Oncology Foundation and from the Serono Foundation. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

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Authors and Affiliations

  1. Fertility and Procreation in Oncology Unit, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy

    Leonora Chiavari & Fedro Alessandro Peccatori

  2. Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy

    Leonora Chiavari, Irene Feroce, Aliana Guerrieri-Gonzaga & Bernardo Bonanni

  3. Division of Cancer Prevention and Genetics, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy

    Sara Gandini

  4. Library, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy

    William Russell-Edu

Authors
  1. Leonora Chiavari
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  2. Sara Gandini
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  3. Irene Feroce
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  4. Aliana Guerrieri-Gonzaga
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  5. William Russell-Edu
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  6. Bernardo Bonanni
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  7. Fedro Alessandro Peccatori
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Corresponding author

Correspondence to Leonora Chiavari.

Additional information

Bernardo Bonanni and Fedro Alessandro Peccatori share senior co-authorship.

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Chiavari, L., Gandini, S., Feroce, I. et al. Difficult choices for young patients with cancer: the supportive role of decisional counseling. Support Care Cancer 23, 3555–3562 (2015). https://doi.org/10.1007/s00520-015-2726-5

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  • DOI: https://doi.org/10.1007/s00520-015-2726-5

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