title: Anticipated regret in shared decision-making: a randomized experimental study.
abstract: BACKGROUND
  Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examined whether regret is a consideration in treatment decisions.
  
  
  METHODS
  In this randomized experimental study, 184 healthy female volunteers were randomized to receive a standard decision aid (control) or one with information on post-surgical regret (experimental). The main outcome measures were the proportion of subjects choosing lumpectomy vs. mastectomy and the proportion reporting that regret played a role in the decision made. We hypothesized that a greater proportion of the experimental group (regret-incorporated decision aid) would make a surgical treatment preference that favored the less regret-inducing option and that they would be more likely to consider regret in their decision-making process as compared to the control group.
  
  
  RESULTS
  A significantly greater proportion of the experimental group subjects reported regret played a role in their decision-making process compared to the control counterparts (78 vs. 65 %; p = 0.039). Recipients of the regret-incorporated experimental decision aid had a threefold increased odds of choosing the less regret-inducing surgery (OR = 2.97; 95 % CI = 1.25, 7.09; p value = 0.014).
  
  
  CONCLUSIONS
  In this hypothetical context, the incorporation of regret in a decision aid for preference-sensitive surgery impacted decision-making. This finding suggests that keying in on anticipated regret may be an important element of shared decision-making strategies. Our results make a strong argument for applying this design and pursuing further research in a surgical patient population.
  
  
  BACKGROUND
  Clinicaltrials.gov, NCT02563808.
authors.affiliation: Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA ; Evidera, 1417 4th Ave., Suite 510, Seattle, WA 98101 USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Speck
authors.affiliation: Department of Anesthesiology and Critical Care, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Neuman
authors.affiliation: Department of Psychiatry, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104 USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Resnick
authors.affiliation: Department of Psychology, Department of Marketing, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104 USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Mellers
authors.affiliation: Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
keywords: Anticipated regret; Breast cancer; Decision-making; Surgery