LeBlanc Annie, Kenny David A, O'Connor Annette M, Légaré France
Research Center, Hopital Saint François d'Assise, Centre Hospitalier Universitaire de Quebec, Université Laval, 10 rue de l'Espinay, Québec, Canada.
Med Decis Making. 2009 Jan-Feb;29(1):61-8. doi: 10.1177/0272989X08327067. Epub 2009 Feb 4.
Decisional conflict is defined as personal uncertainty about which course of action to take when choice among competing options involves risk, regret, or challenge to personal life values. It is influenced by inadequate knowledge, unclear values, inadequate support, and the perception that an ineffective decision has been made. Until recently, it has been studied at the individual level, which ignores the interpersonal system between patients and physicians.
To explore the effect of feeling uninformed, unclear values, inadequate support, and the perception that an ineffective decision has been made on one own's outcome (actor effect) and on the other person's outcome (partner effect).
After a clinical encounter, modifiable deficits and personal uncertainty were measured in physicians and patients using the Decisional Conflict Scale. Structural equation modeling was used to measure the parameters of the Actor-Partner Interdependence Model.
A total of 112 dyads of physicians and patients were included in the analysis. For both patients and physicians, 2 actor effects, unclear values (P < 0:0001) and the perception that an ineffective decision has been made (P < 0:0001), were found to be positively correlated with personal uncertainty. One partner effect, feeling uninformed (P=0:03), was found to be negatively correlated with personal uncertainty.
Personal uncertainty of patients and physicians is influenced not only by their respective deficits but also by the deficits of the other member of the dyad. Our results indicate that the more unclear the expression of their own values and the more they perceive that an ineffective choice had been made, the more both physicians and patients experience personal uncertainty. They also indicate that the less uninformed they feel, the more both physicians and patients experience personal uncertainty.
决策冲突被定义为当在相互竞争的选项中进行选择涉及风险、遗憾或对个人生活价值观的挑战时，个人对于采取何种行动方针的不确定性。它受到知识不足、价值观不明确、支持不足以及认为做出了无效决策的认知的影响。直到最近，它一直是在个体层面进行研究，而忽略了患者与医生之间的人际系统。
探讨信息不足、价值观不明确、支持不足以及认为做出了无效决策对自身结果（行动者效应）和他人结果（伙伴效应）的影响。
在一次临床接触后，使用决策冲突量表对医生和患者的可改变缺陷和个人不确定性进行测量。采用结构方程模型来测量行动者 - 伙伴相互依赖模型的参数。
分析共纳入了112对医生和患者。对于患者和医生而言，发现两种行动者效应，即价值观不明确（P < 0.0001）和认为做出了无效决策（P < 0.0001），与个人不确定性呈正相关。发现一种伙伴效应，即信息不足感（P = 0.03），与个人不确定性呈负相关。
患者和医生的个人不确定性不仅受到他们各自缺陷的影响，还受到二元组中另一方缺陷的影响。我们的结果表明，他们自身价值观的表达越不明确，以及他们越认为做出了无效选择，医生和患者所体验到的个人不确定性就越大。结果还表明，他们感觉信息不足的程度越低，医生和患者所体验到的个人不确定性就越大。
