Regret mediates the relationship between decisional conflict and psychological distress among women choosing breast cancer surgery

Abstract

BACKGROUND: This study examined the med-iating effect of decision regret on the relationshipbetween decisional conflict and psychological dis-tress among women choosing breast cancer sur-gery. METHOD: A prospective study examinedtreatment decision making and psychological dis-tress in a convenience sample of Chinese womenrecently diagnosed with early-stage breast cancer(BC). Totally 195 (93% response rate) women withBC recruited from a major Hong Kong breastcentre were assessed at 3 days after the initialdiagnostic consultation (Baseline) and at 1-monthfollowing BC surgery (Follow-up). DecisionalConflict was assessed at Baseline, whereas DecisionRegret, Psychological Distress, Physical SymptomDistress, and Optimism were assessed at Follow-up. Forced-entry multiple regression analysestested the mediating effect of decision regret onthe relationship between decisional conflict anddistress. RESULTS: The average age of the womenwas 53 years old. Half of the women hadmastectomy and 31% had breast conserving surgery.Higher decisional conflict (b 5 .20, p 5 .008)resulted in higher regret (F(1,184) 5 7.24, p 5 .008).Higher decisional conflict (b 5 .142, p 5 .014) alsoresulted in greater distress at 1-month post-surgery(F(3,142) 5 37.05, po.001). After adjusting for the effects of physical symptom distress, age, andoptimism, decisional conflict (b 5 .120, p 5 .037)and regret (b 5 .151, p 5 .008), explained 45% ofthe variance in distress (F(5,179) 5 31.01, po.001).The Sobel test indicated that regret was a mediatorof the effect of decisional conflict on distress(z 5 2,74, p 5 .003 ). CONCLUSIONS: The effectof decisional conflict in choosing BC surgery onsubseque nt psychological distress was partiallymediated by decision regret. RESEARCH IMPLI-CATIONS: Future studies need to investigateconsul tation and other factors, contributing todecision conflict and regret. CLINICAL IMPLICA-TIONS: Optimizing TDM support aiming to reducedecision uncertainty and regret is potentially im-portant preventive strategy to minimize psychologi-cal distress following breast cancer. ACKNOWL-EDGEMENT OF FUNDING: None.