PATIENT DECISION AID STUDY FEEDS BACK TO THEORY: TESTS OF DIFFERENTIATION AND CONSOLIDATION

Monday, October 21, 2013
Key Ballroom Foyer (Hilton Baltimore)
Poster Board # P2-5
Decision Psychology and Shared Decision Making (DEC)

Deb Feldman-Stewart, PhD1, Christine Tong2, Ola Svenson, Phd3 and Michael Brundage, MD, MSc2, (1)Division of Cancer Care and Epidemiology, Kingston, ON, Canada, (2)Queen's University, Kingston, ON, Canada, (3)University of Stockholm, Stockholm, Sweden
Background: The results of patient decision aid (PtDA) studies provide an opportunity to test decision-making theory.  We had conducted a randomized controlled trial (RCT) comparing our early-stage prostate cancer PtDA with values clarification exercises to a control without the exercises.  Svenson's Differentiation and Consolidation ("Diff Con") is a descriptive theory of decision making that postulates decision processes which gradually differentiate a most-preferred choice from the others (called "Differentiation"), and post-decision processes to further support the choice against later-occurring threats to its selection (called "Consolidation").  The RCT data allowed us to test Diff Con postulates.

Purpose:  To test three sets of hypotheses derived from Diff Con. The sets focussed on (a) differentiation, (b) consolidation, and (c) the relationships between the decision processes and the outcomes of decisional conflict and regret.

Method: Data from both RCT arms were pooled to test six hypotheses.  Differentiation and consolidation scores were determined by calculating the difference between the values [scale: 1 (least)-5 (most)] of the most-preferred choice and its closest competitor.  For brevity, we report one example hypothesis from each set:  (a) related to differentiation—differentiation increases gradually over time, (b) related to consolidation—the relative value of the choices continues to change after the decision is made, and (c) related to the decision-process relationships—greater consolidation is associated with lower regret (measured by O'Connor's Decision Regret Scale). 

Results:  All six hypotheses were supported, though limitations were identified.  (a) Differentiation:  mean differentiation scores shifted from 1.25 at pre-PtDA to 1.63 at post-PtDA (N=126; F=14.67, p<.001), to 2.06 at 1-week post-decision (N=126; F=8.44, p=0.004). (b) Consolidation:  mean consolidation scores shifted from 1.89 at 1-week post-decision to 2.53 at 3-months post-treatment (N=81; F=14.1, p<.001), to a non-different 2.06 at 1-year post-treatment (N=81; F=0.72, p=0.4);  (c) Decision-process relationships:  consolidation scores were negatively associated with regret scores at 3-months post-treatment ( r= -0.31, p<0.001) but the relationship was only a trend at 1-year post-treatment (r= -0.18, p=.08). 

Conclusion: Data from this PtDA study support the hypotheses derived from Diff Con, and the tests help clarify specifics about decision processes that occur in the context of this decision.