title: Effects of a decision support intervention on decisional conflict associated with microsatellite instability testing.
abstract: BACKGROUND
  Decision support to facilitate informed consent is increasingly important for complicated medical tests. Here, we test a theoretical model of factors influencing decisional conflict in a study examining the effects of a decision support aid that was designed to assist patients at high risk for hereditary nonpolyposis colorectal cancer (CRC) deciding whether to pursue the microsatellite instability (MSI) test.
  
  
  METHODS
  Participants were 239 CRC patients at high familial risk for a genetic mutation who completed surveys before and after exposure to the intervention. Half of the sample was assigned to the CD-ROM aid and half received a brief description of the test. Structural equation modeling was employed to examine associations among the intervention, knowledge, pros and cons to having MSI testing, self-efficacy, preparedness, and decisional conflict.
  
  
  RESULTS
  The goodness of fit for the model was acceptable [FIML, full information maximum likelihood, χ(2) (df = 280) = 392.24; P = 0.00]. As expected, the paths to decisional conflict were significant for postintervention pros of MSI testing (t = -2.43; P < 0.05), cons of MSI testing (t = 2.78; P < 0.05), and preparedness (t = -7.27; P < 0.01). The intervention impacted decisional conflict by increasing knowledge about the MSI test and knowledge exerted its effects on decisional conflict by increasing preparedness to make a decision about the test and by increases in perceived benefits of having the test.
  
  
  CONCLUSIONS
  Increasing knowledge, preparedness, and perceived benefits of undergoing the MSI test facilitate informed decision making for this test.
  
  
  CONCLUSIONS
  Understanding mechanisms underlying health decisions is critical for improving decisional support. Individuals with Lynch syndrome have an elevated lifetime risk of CRC. Risk of Lynch syndrome may be assessed with a tumor-based screening test (MSI testing or immunohistochemical tissue staining).
authors.affiliation: Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. michael.hall@fccc.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hall
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Manne
authors.forename: Gary
authors.initials: G
authors.lastname: Winkel
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chung
authors.forename: David S
authors.initials: DS
authors.lastname: Weinberg
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
mesh_terms: D016251:CD-ROM; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis / Q000235:genetics*; D003661:Decision Support Techniques; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006266:Health Education; D006801:Humans; D053842:Microsatellite Instability; D015233:Models, Statistical