The decisional conflict scale: further validation in two samples of Dutch oncology patients

The importance of patient involvement in medical decision making is indispu table. Yet, decision making concerning medical treatment options is a diffi cult task for most patients. In order to study decision-making processes in health care, O'Connor developed the decisional conflict scale (DCS). The D CS assesses the level of 'decisional conflict' that patients experience whi le making health care decisions, and encompasses the following three subsca les: (1) uncertainty about choosing among alternatives; (2) factors contrib uting to uncertainty; (3) perceived effectiveness of the decision. The aim of the present study is to investigate the reliability and validity of the Dutch version of the DCS. A written version of the DCS was administered in two samples of Dutch cancer patients. One sample consisted of cancer patien ts faced with the decision whether or not to undergo palliative chemotherap y (N = 29). The other sample included women with early stage breast cancer who had to choose between mastectomy or lumpectomy followed by radiation th erapy (N = 141). The response rates were 76% and 91%, respectively. The rel iability coefficients of the three subscales were 0.52, 0.80, 0.84, and 0.7 4, 0.83, 0.83 in the two samples, respectively. Construct validity was part ly supported. Criterion validity was substantiated. In evaluating the facto rial validity, it was found that the original three-factor model had to be rejected (chi (2)(87) = 293, root mean square error of approximation (RMSEA ) = 0.137). A subsequent exploratory factor analysis suggested an alternati ve four-factor model. The psychometric properties of the DCS were partly co nfirmed in Dutch cancer patients. Improved 'wording' of certain items, e.g. to avoid double negatives, could further increase the factorial validity o f the DCS. Then, this scale may be a valuable tool for studies that address the quality of medical decision making. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.