Assessing And Supporting Adolescents Capacity For Autonomous Decision Making In Health Care Settings PDF Download

Adolescents and young adults (AYA) faced with complex medical conditions encounter a number of treatment decisions but may have variable levels of desire for involvement in medical decision-making. Currently, there are few studies quantifying decision-making preferences in the AYA population. This dissertation work evaluated the degree of decisional control AYA patients preferred to have in medical decisions and to what extent factors such as self-efficacy for decision-making, social and autonomy support, and self-regulatory skills predict role preferences of decision control. A crosssectional,descriptive correlational design examined AYA patient decision-making role preferences using the Control Preference Scale and explored relationships in a proposed conceptual model of decision control in this population. A total of 46 AYA patients with various complex medical diagnoses completed the study. Overall, the majority of patients preferred active collaborative (39%) or shared decision-making (34%) roles. Further analyses revealed a statistically significant difference based on medical diagnosis in this sample, with oncology AYA patients preferring a more passive role by comparison to non-oncology AYA patients. Time since diagnosis also positively correlated with control preference, with patients preferring a more active level of decisional control as the number of days from diagnosis increased. While no other statistically significant relationships were found between factors put forth in the exploratory study model and decision control, there were strong associations between the factors themselves that warrant future exploration. Self-efficacy for decision-making was strongly correlated with other factors, such as social support, perceived autonomy, and self-regulatory skill. Perceived autonomy and medical diagnosis predicted the degree of shared decisionmaking that was reported by AYA patients in this study. The findings advance the knowledge of AYA preferences for medical decision-making involvement, which enhances our ability to identify patients at risk for low healthcare engagement in their treatment planning and self-management. This dissertation provides a foundation forfuture research to explore the consequences of limited or impaired decisional capacity and preferences for low involvement so that healthcare providers can balance the need to promote self-management with the patient desire for decisional control.