Decisional Conflict among Women Eligible for Loop Electrosurgical Excision Procedures
Creators: name: Ohadugha, Anayo
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2016

description: Abstract Introduction: Decisional conflict is a state of uncertainty about a course of action. It is more likely to occur when one has to make a decision involving risk and uncertainty of outcomes or when significant potential gains and losses are presented. Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that can be confirmed histologically from a biopsy sample and is categorized into three stages (CIN 1, 2, and 3). The most common treatment for cervical intraepithelial neoplasia is Loop Electrosurgical Excision Procedure (LEEP). Several studies have shown an association between LEEP and the risk for preterm delivery. In order to collect information on the decisional conflict among women eligible for LEEP procedures and characterize the association between decisional conflict and the demographics of race, age, educational status, and language, a systematic review and an analysis of primary data from UNC Women’s Hospital Dysplasia Clinic was performed. The literature review highlights clinical implications for the decision making process in regards to treatments for precancerous and cancerous lesions. Methods: The systematic review was performed using several academic search engines. The decisional conflict among women eligible for LEEP procedures was too narrow of a topic for a systematic review. As a result, the focus of the systematic review was expanded to decisional conflict among women eligible for any type of treatment for cancer or cancer prevention. Exclusion and inclusion criteria determined which studies were fully reviewed. Studies were reviewed for their overall quality, external and internal validity, and strength of evidence. The primary data analysis was performed using survey data collected between April 2016 and May 2016 from patients at the UNC Women’s Hospital Dysplasia Clinic who were eligible for LEEP procedures. English and Spanish versions of the Decisional Conflict Scale were utilized to measure decisional conflict and information about patient demographics (age, race, education) was also collected. Results: The review found that decisional conflict can be significantly reduced through the utilization of decisional aids when discussing cancer treatment. In the primary data analysis, the overall cohort had a low level of decisional conflict and no statistically significant differences were found based on patient demographics. Conclusions: Decisional aids are tools that can be utilized during the consent process to decrease patient decisional conflict while increasing patient knowledge and satisfaction. This ultimately can increase the quality of care provided. There is not enough literature on the relationship between decisional conflict and patient demographics such as age, race, educational status or language. Future patient surveys should be conducted using the Decisional Conflict Scale with a larger sample size in order to analyze potential differences between demographic groups that this study may have not found and to ensure that patients have low decisional conflict prior to LEEP procedures.