title: Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment.
abstract: BACKGROUND
  Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions.
  
  
  METHODS
  320 women aged 20-79 diagnosed with AJCC stage 0 - III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach's alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation.
  
  
  RESULTS
  For overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of "Right for You" for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively.
  
  
  CONCLUSIONS
  Our measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of information, time, and involvement. Future research is needed to establish norms for the measure as is further psychometric testing, particularly to examine how it is associated with outcomes such as quality of life, psychological coping and objective decision quality.
authors.affiliation: University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA. kresnic@umich.edu.
authors.forename: Ken
authors.initials: K
authors.lastname: Resnicow
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. pabraham@med.umich.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Abrahamse
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. rtocco@med.umich.edu.
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Tocco
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. sarahawl@med.umich.edu.|Veterans Administration, Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, Building 16, Rm. 421 W, Ann Arbor, MI, 48109-2800, USA. sarahawl@med.umich.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hawley
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. jengrigg@med.umich.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Griggs
authors.affiliation: University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA. nkjanz@umich.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Janz
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. fagerlin@med.umich.edu.|Veterans Administration, Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, Building 16, Rm. 421 W, Ann Arbor, MI, 48109-2800, USA. fagerlin@med.umich.edu.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.affiliation: University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA. deebz@umich.edu.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Emory University, Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA. kward@emory.edu.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.affiliation: Department of Surgery, Emory University School of Medicine, Winship Cancer Institute of Emory University, 69 Jesse Hill Jr. Dr. SE, Room 303, Atlanta, GA, 30303, USA. sgabram@emory.edu.
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
authors.affiliation: University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. skatz@med.umich.edu.
authors.forename: Steven
authors.initials: S
authors.lastname: Katz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D054626:Consumer Health Information / Q000592:standards*; D003657:Decision Making; D005260:Female; D005845:Georgia; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009518:New York; D010358:Patient Participation; D017060:Patient Satisfaction; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D055815:Young Adult