title: Participation and conflict in the decision-making process for endoscopic resection or surgical gastrectomy for early gastric cancer.
abstract: BACKGROUND
  This study was to evaluate the participation role and conflict of patients during the decision-making process for endoscopic or surgical treatment for early gastric cancer (EGC).
  
  
  METHODS
  In this prospective observational study, the sequential survey for patients under consideration for treatment of differentiated EGC was performed at the tertiary referral center.
  
  
  RESULTS
  Among the 82 responders, 63.4% preferred endoscopic resection. The total decisional conflict scores were high and significantly different between groups that preferred endoscopic resection or surgical treatment (44.8 vs. 51.6, P = 0.016). Values assigned to the two treatment attributes "preservation of stomach (OR = 0.51)" and "bother in case of incomplete resection (OR = 2.13)" clearly discriminated between patients reaching a final decision of surgical gastrectomy or endoscopic resection. Regarding the participation role, a shared role was more frequent in the group with preference for endoscopic treatment before consultation (42.3% vs. 24.0%, P = 0.045). However, at the time of therapeutic decision, the passive role was most remarkable, both for the endoscopic (53.2%) and surgical (71.4%) groups.
  
  
  CONCLUSIONS
  Despite the high overall decisional conflict, patients with preference for endoscopic treatment tended to be more autonomous. After consultation, all patients exhibited a passive participation role in the decision-making process.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. leeyc@yuhs.ac
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Suji
authors.initials: S
authors.lastname: Shin
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
mesh_terms: D000328:Adult; D000368:Aged; D003220:Conflict, Psychological; D003657:Decision Making; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D010358:Patient Participation / Q000706:statistics & numerical data; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011446:Prospective Studies; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D035501:Uncertainty