The effect of shared decision making on self-efficacy and decision satisfaction in women with abnormal cervical cytology: An experimental study

Abstract

Abstract Introduction: Cervical cancer can be early diagnosed and prevented. Pap smear is a cheap, affordable and convenient way to screen for cervical cancer. Results in the form of mild abnormal changes of unknown importance are the most common results reported from a Pap smear test. Lack of consensus in the management of such changes, due to patients' lack of awareness leads to anxiety and confusion. Therefore, in this study, we aimed to increase women's awareness by providing decision support tools in the form of booklets and direct advice on available methods for managing ASCUS so that they can make appropriate choices based on their circumstances and preferences. Methods and Materials: The present study was an interventional study on 54 women aged 21 to 63 years who had a positive Pap smear report in ASCUS and LSIL. Participants were randomly assigned to the intervention and control groups in equal 1: 1 ratios. Data were collected using questionnaires of social and obstetric characteristics, shared decision making, decision conflict, decision satisfaction and decision self-efficacy and anxiety before and after the intervention by interview and analyzed by SPSS24 software. Independent t-test and ANCOVA were used. Results: The results of this study indicate that after using the decision aid in the intervention group, the mean self-efficacy was [mean difference of 14.56 with 95% confidence interval and (21.47 to 7.65), (0.001). P <0), decision satisfaction, with [mean difference: 6.43 with 95% confidence interval and (7.76 to 3.11), (P <0.03)] and mean score of joint decision with [Mean difference of 6.28 with 95% confidence interval and (10.57 to 2.00), (P = 0.001)] increased significantly compared to the control group. Decision contradiction and its sub-domains [mean difference: -22.84 with confidence interval: 95% and (-21.95 to -23.52), (P 0.001)] had a significant decrease compared to the control group. The mean score of anxiety after the intervention was reduced by [mean difference of 1.20 and 95% confidence interval and (2.90 to -0.5), (P = 0.19)] compared to the control group, but this difference was statistically significant. It was not meaningful. Conclusion: According to the results of this study, it can be said that the use of shared decision making along with the decision aid booklet can be an effective way to make health-related decisions in patients, especially in important diseases such as cervical cancer, in accordance with the values of individuals to help understand the advantages and disadvantages of screening methods in patients, so it is recommended to provide counseling services with decision aid booklets for women with mild abnormal Pap smear as an important step to be considered to promote women's health.