Background
There are three different treatment options for the newly diagnosed Vestibular Schwannomas (VS) patient. Lack of information about treatment risks and benefits is the foremost barrier to making treatment decisions. The goal of this study was to develop and validate a decision aid (DA) for newly diagnosed VS patients.

Methods
This was an instrument development and randomized control validation trial. The 15 items on the DA were identified through virtual focus groups of VS patients, discussion with treating physicians, and literature review. 77 newly diagnosed patients who had not yet made treatment decision were screened and 58 met enrollment criteria. Subjects completed initial questionnaires and were randomized into either an intervention group consisting of the DA and a fact sheet on VS from the National Institute of Deafness and Other Communication Disorders (NIDCD), or a control group that only received the fact sheet. Subjects were expected to use the materials as they completed initial visits with various physicians. The hypothesis of the study was that the use of the DA would increase shared decision- making and increase subject satisfaction with their decision as demonstrated by a reduction in scores on the Decisional Conflict Scale (DCS), which measures personal perceptions of uncertainty in choosing options; modifiable factors contributing to uncertainty; and effective decision-making. Total score ranges from 0 (no decisional conflict) to 100 (extremely high decisional conflict). A clinically meaningful level of no decisional conflict for VS patients was defined as a DCS score ≤ 1.

Results
At baseline, the median DCS for the DA group was 1.81 (Range: 1.00-3.00) and for the Control group was 1.88 (Range: 0.69 to 3.19). At Time 2, the median DCS for the DA group was 1.16 (Range: 0-1.88) and for the Control group was 1.31 (0.06-2.81). The (ΔDCS) between Time 1 and Time 2 for the DA group was 0.91 (Range: -0.50 to 2.06) and for the Control group was 0.56 (Range: -0.63 to 2.06). In the DA group, 46% of individuals had a DCSTime 2 ≤ 1 compared to 33% of individuals in the Control group, a 13% reduction in decisional conflict.

Conclusion
The use of the VS DA at the time of making a treatment decision showed a clinically meaningful difference in reducing decisional conflict. Decision aids are helpful in decreasing decisional conflict and increase decision satisfaction and shared-decision-making.

Development and Validation of a Decision Aid for Newly Vestibular Schwannoma Patients

 Otolaryngology - Head and Neck Surgery

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