The Impact of Caregivers Role Preference on Decisional Conflicts and Psychiatric Distresses in Decision Making to Help Caregivers Disclosure of Terminal Disease Status

Abstract

Introduction: Decision aid facilitates resolution of decisional conflicts and helps patients make informed decision by weighing the benefits and risks of possible choices in difficult decision making in healthcare. However, little is known about relationship between preferred role in decision making and outcomes of decision aid intervention. The objective of this study was to investigate the impact of caregivers decisional role preference on decisional conflicts and psychiatric distresses in decision making. Methods: 406 of 444 caregivers of terminally ill cancer patients enrolled onto a previous trial determining the efficacy of the decision aid (DA) about disclosure of terminal disease status were included in this analysis. The analysis outcomes were change score of decisional conflicts using the Decision Conflict Scale (DCS) and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) at 1 and 3 months from baseline. Participants were divided into 4 groups: active caregiver who received DA (active-DA), active caregiver in control group (active-control), passive caregiver who received DA (passive-DA), and passive caregiver in control group (passive-control). Linear mixed model adjusted for caregivers marital status, educational status, and income level was conducted to find out the impact of caregivers decisional role preference on the DCS and the HADS. Results: Among 406 caregivers, 137 (33.7%) showed active role preference, and 269 (66.3%) showed passive role preference. In post-hoc analysis of adjusted differences of change scores between passive-DA and active-DA groups, non-significant differences were observed in DCS. However, at 3 months, change scores of HADS depression subscale increased as 4.43 (95% confidence interval (CI), 0.78-8.07

P<0.007) and those of HADS anxiety subscales increased as 4.14 (95% CI, 0.37-7.91

P=0.021) in passive-DA group than in active-DA group. Conclusions: These findings suggest that information about decision making might be provided with tailored format for how much individual wish to involve in decision making.