ASSESSMENT OF DIET-RELATED DECISIONAL CONFLICT IN PATIENTS AND THEIR DIETITIANS

Purpose: The increased number of evidence-based dietary options and the rapid and unregulated influx of readily available nutrition information suggest that the need for patient guidance and decision support from dietitians will increase in the near future. The purpose of this study was to assess decisional conflict in patients and their dietitians following a clinical encounter.

Method: Nineteen unique patient-dietitian dyads were recruited at the Quebec University Hospital Center. Following a clinical encounter in which a diet-related decision was made, both members of the dyad completed independently a questionnaire assessing socio-demographics, the quality of the decision that had been made during the encounter (using a scale from 1 to 10, 1 representing the lowest quality level and 10 the highest quality level), and the respective level of decisional conflict they experienced using the Decisional Conflict Scale (a multidimensional scale of 16 items, each scored on a 5-point Likert scale). The agreement between patient's and dietitians' decisional conflict scores was measured using Spearman correlation coefficients.

Result: Nineteen out of 40 eligible dietitians agreed to participate to the study. Each participating dietitian recruited one patient. Dietitians were aged between 24 and 60 years old (mean age 39.3 ± 11.0 years; 100% female). Patients (mean age 40.2 ± 25.2 years; 58% female) were consulting in either inpatient or outpatient hospital clinical settings for a variety of diet-related health conditions including diabetes, cardiovascular diseases, and high blood pressure. Decisional conflict scores were significantly higher in dietitians than in patients (P<0.01). The number of years in practice of dietitians was positively associated with decisional conflict scores (r=0.58, P<0.05). For both dietitians and patients, a lower decisional conflict score was associated with a higher perception of the quality of the decision (r= -0.55, P<0.05 and r= -0.67, P<0.01, respectively). Spearman correlation coefficients showed no statistically significant agreement between patients’ and dietitians’ decisional conflict scores (r= -0.21 P=0.38).

Conclusion: This is the first study assessing decisional conflict in patients and their dietitians following a clinical encounter. The current findings suggest that future interventions aiming to improve the quality of diet-related decisions would gain from devoting more attention to decisional conflict and to the mutual agreement of patients and dietitians on the decision-making process.