Consent from the family of a possible donor directly influences organ donation rates. The process of obtaining consent, however, is often addressed during a time in which the family’s ability to make decisions is affected by the psychological trauma related to the sudden and unexpected reality of death. This research study implemented a qualitative interpretive descriptive design to gain insight into the way family members of brain-dead patients try make sense of the conflict they experience while faced with a compelling decision about organ donation. Data was collected during in-depth, unstructured, individual interviews with family members (n=8), representing the diverse population of the Western Cape Province in South Africa. Digitally voice-recorded interviews were transcribed, followed by thematic data analysis. Seven common themes emanated from the data, which clarified the family’s decisional conflict regarding organ donating to a certain degree. Although the findings of the study resonate with several similar international studies, it also brings new insight to the role played by the so-called key decision maker(s) in the family. The key decision maker carries the greatest weight in the family’s final decision, and must acquire an informed understanding of both brain death and organ donation. Understanding the role of the key decision maker may well be crucial to the supporting transplant coordinator during the time of decision-making. Recommendations were formulated for education, policy, practice and further research. / MCur, North-West University, Potchefstroom Campus, 2015

Consent from the family of a possible donor directly influences organ donation rates. The process of obtaining consent, however, is often addressed during a time in which the family’s ability to make decisions is affected by the psychological trauma related to the sudden and unexpected reality of death. This research study implemented a qualitative interpretive descriptive design to gain insight into the way family members of brain-dead patients try make sense of the conflict they experience while faced with a compelling decision about organ donation. Data was collected during in-depth, unstructured, individual interviews with family members (n=8), representing the diverse population of the Western Cape Province in South Africa. Digitally voice-recorded interviews were transcribed, followed by thematic data analysis. Seven common themes emanated from the data, which clarified the family’s decisional conflict regarding organ donating to a certain degree. Although the findings of the study resonate with several similar international studies, it also brings new insight to the role played by the so-called key decision maker(s) in the family. The key decision maker carries the greatest weight in the family’s final decision, and must acquire an informed understanding of both brain death and organ donation. Understanding the role of the key decision maker may well be crucial to the supporting transplant coordinator during the time of decision-making. Recommendations were formulated for education, policy, practice and further research. / MCur, North-West University, Potchefstroom Campus, 2015

The present study aimed to analyse the factor structure of the Melbourne Decision Making Questionnaire (DMQ-II), and to examine the relationships between the factors identified and Self-confidence, in order to conceptualize the decision-making process in adolescents under the Conflict Model of Decision Making. Participants were 992 Mexican high-school students, aged between 15 and 19 years. The three factors were identified as decision-making patterns in adolescents: a) Vigilance, b) Hipervigilance/Procrastination and c) Buck-passing. The Self-confidence showed a positive effect on Vigilance, and a negative effect on theother two patterns. Results are discussed considering the literature on decision making in adolescence. / El presente estudio se propuso analizar la estructura factorial del Cuestionario Melbourne sobre Toma de Decisiones, y estudiar las relaciones entre los factores identificados y la Autoconfianza, con la finalidad de conceptualizar la toma de decisiones de los adolescentes en elmarco del Modelo de Conflicto de Decisión. Los participantes fueron 992 estudiantes mexicanos de bachillerato con edades entre 15 y 19 años. Se identificaron tres factores interpretados como patrones de toma de decisiones en adolescentes: a) Vigilancia, b) Procrastinación/Hipervigilancia y c) Transferencia. La Autoconfianza resultó tener un efecto positivo sobre Vigilancia, y un efecto negativo sobre los otros dos patrones. Se discuten estos y otros resultados considerando la literatura sobre toma de decisiones en la adolescencia.

No description available.

This study aimed to establish a connection, if any, between perceptions of information disclosure about medical treatment and decisional conflict in bereaved parents of children with cancer. Decisional regret was an important theme in this exploration because decisional conflict strongly aligns with the propensity to mentally redo past events, thereby forming counterfactual alternatives to reality. People generate counterfactuals to hypothesize a more favorable outcome subsequent to a negative event or the death of a child as applicable to this study. A secondary objective was to investigate the potential influence of counterfactual processing and regret on the construct of self-acceptance: a phenomenon researchers have rarely studied in the population of interest. Study participants included parents who lost a child to cancer in the United States after participating in medical treatment prescribed by a licensed oncologist. Cluster and convenience sampling were employed to recruit 92 participants. Quantitative methods were used in obtaining data samples through validated instruments for each independent and dependent variable. The responses collected indicate that a perceived lack of information disclosure about treatment risks and efficacy, yield a positive influence on decisional conflict after the death of a child. Similarly, decisional conflict positively correlates with decisional regret, while the latter negatively correlates with self acceptance in the bereavement process. The research implications call for additional studies that further isolate factors that contribute to decisional conflict. This study advocates for decision making tools and collaborative processes that ensure parents are well informed and involved in making medical decisions from diagnosis through palliative care, if a cure is not possible.

No description available.

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.