Getting Specific: Participation Preference in Urooncological Decision-making

Overview

Journal BMC Med Inform Decis Mak

Publisher Biomed Central

Specialty Medical Informatics

Date 2023 Jul 5

PMID 37407999

Authors

Bjorn Budenbender

Anja K Kother

Maximilian C Kriegmair

Britta Grune

Maurice S Michel

Georg W Alpers

Affiliations

Soon will be listed here.

Abstract

Background: Shared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference.

Methods: In Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed.

Results: Study 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001.

Conclusions: The desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.

Citing Articles

Power asymmetry and embarrassment in shared decision-making: predicting participation preference and decisional conflict.

Scherer K, Budenbender B, Blum A, Grune B, Kriegmair M, Michel M BMC Med Inform Decis Mak. 2025; 25(1):120.

PMID: 40065322 PMC: 11892210. DOI: 10.1186/s12911-025-02938-4.

Factors Influencing Patient Decision-Making in the Treatment of Muscle-Invasive Bladder Cancer.

Desai A, Bouknight L, Reed T, Mueller D, Osterman C, Repka M Bladder Cancer. 2024; 10(2):145-155.

PMID: 39131874 PMC: 11308634. DOI: 10.3233/BLC-240002.

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