title: Difficult choices for young patients with cancer: the supportive role of decisional counseling.
abstract: OBJECTIVE
  The aim of patient decisional support interventions is to promote shared decision making. Many of these interventions are comprehensive of information and guidance. In this pilot study, we evaluate the effects of a decision-making support (decision counseling (DeCo)) on decision making, decisional conflict, and anxiety in cancer patients facing with values-based decisions on fertility and procreation or genetic testing and risk reduction options in oncology.
  
  
  METHODS
  DeCo was proposed during the medical consultation. The following questionnaires were administered to 54 patients before the DeCo session and 1 week after it: stage of decision making (SDM), decisional conflict scale (DCS) and subscales ("uncertainty," "informed," "clarity," "support," and "effective decision"), state-trait anxiety inventory. Decision Support Questionnaire and Usefulness of Decision Counseling were created ad hoc for this study. Multivariate logistic models and ANCOVA models were used to investigate the changes of SDM and DCS in association with DeCo.
  
  
  RESULTS
  We found a significant improving in SDM with DeCo (P = 0.01) and a significant reduction in DCS with DeCo (P = 0.007) measured with the Decision Support Questionnaire. In particular, the DCS informed subscale showed a significant decrease in time (P = 0.002).
  
  
  CONCLUSIONS
  DeCo is useful to facilitate decision making and reduce decisional conflict. It plays a role in the perception of being informed while not directly providing clinical information. This model of decisional support intervention, in which information is provided only by the clinician and decisional support is focused on personal aspects that influence the decision, could improve shared decision making between patient and clinicians.
authors: Fertility and Procreation in Oncology Unit, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. leonora.chiavari@gmail.com.|Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. leonora.chiavari@gmail.com.
authors: Leonora
authors: L
authors: Chiavari
authors: Division of Cancer Prevention and Genetics, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. sara.gandini@ieo.it.
authors: Sara
authors: S
authors: Gandini
authors: Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. irene.feroce@ieo.it.
authors: Irene
authors: I
authors: Feroce
authors: Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. aliana.guerrierigonzaga@ieo.it.
authors: Aliana
authors: A
authors: Guerrieri-Gonzaga
authors: Library, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. william.russell-edu@ieo.it.
authors: William
authors: W
authors: Russell-Edu
authors: Division of Epidemiology and Biostatistic, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. bernardo.bonanni@ieo.it.
authors: Bernardo
authors: B
authors: Bonanni
authors: Fertility and Procreation in Oncology Unit, European Institute of Oncology, via Ripamonti, 435, 20141, Milan, Italy. fedro.peccatori@ieo.it.
authors: Fedro Alessandro
authors: FA
authors: Peccatori
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003376:Counseling / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010865:Pilot Projects
keywords: Decision counseling; Decision support; Patient decision aids; Shared decision making; Values-based decisions