A psychometric study of the decisional conflict scale in surrogate decision makers.
Kristen E Pecanac, Roger L Brown, Jay Steingrub and 3 others
PMID 30054105WHAT IT FOUND
The Decisional Conflict Scale appears usable in 472 ICU surrogate decision makers making decisions about life-sustaining treatment.
It captures informed, values, support, uncertainty and effective decision ratings, and can be used for men and women.
Key findings
01The scale fit five parts in surrogates: informed, values clarity, support, uncertainty and effective decision-making.
02Each part had appropriate internal consistency, and the scale could be used by parts or as an overall measure.
03Men and female surrogates could be compared, but men found the item about choosing without pressure from others harder.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Surrogates were recruited by convenience sampling from five academic medical centers, and 81% of surrogates and 85% of patients were White, so the scale was not tested across racial groups. Only male and female surrogate gender was compared; the analysis did not test age, relationship to the patient, or patient age. Most surrogates agreed or strongly agreed with 15 of the 16 items, so many items did not show much variation. The study tested measurement properties only, not whether using the scale changes care or outcomes. Missing responses were 4.5% and were not missing completely at random, so the analysis had to fill them in with a statistical method.
Declared interests
The supplied metadata says the work was supported by NIH extramural research. The article text supplied does not include the funding or conflict-of-interest declaration, so it does not say whether the funder designed, analysed or wrote the study.
The easy way to misread this
Do not conclude that giving surrogates the scale will reduce conflict or improve decisions. The study only tested whether the scale measures decisional conflict in ICU surrogates, and most responses were concentrated on agree or strongly agree, so it does not show what happens when clinicians use it.