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Is clinically significant decisional conflict prevalent in primary care? A scoping review

Date and Location




Saturday 21 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Audrey Ferron Par...

Contact person

France Légaré
Abstract text
Background: Clinically significant decisional conflict (CSDC) refers to a decisional conflict that is likely to have harmful effects on a patient. Objectives: We aimed to explore the prevalence of CSDC reported in primary care studies by systematically reviewing published literature. Methods: We searched PubMed and Web of Science using the keywords “decisional conflict AND/OR decisional conflict scale” up to February 2012. We included original studies conducted in primary care published in English or French. Eligible studies had to specify a threshold on the Decisional Conflict Scale (DCS) at which they considered a decisional conflict to be clinically significant, and the proportion of patients scoring above or below this threshold. Two reviewers identified eligible studies independently. We extracted study characteristics, the DCS version used (10 or 16 items), the threshold for CSDC and the proportion of patients above this threshold. Results: We found 386 potentially eligible studies, of which 262 had used the DCS. Only 12 studies (4.6%) met all inclusion criteria (Kappa coefficient = 0.87). All studies were published between 2006 and 2011, and were conducted in Canada (n=4), the USA (n=3), the UK (n=2), Australia (n=2) and Japan (n=1). Most were conducted in English (n=8) and used the 16-item DCS (n=10). The most common clinical settings were maternal-fetal health (n=5), vasectomy (n=2) and cancer screening (n=2). Seven studies used a DCS threshold of 25/100 to establish the prevalence of CSDC, while five used a threshold of 37.5/100. Reported prevalence of CSDC ranged from 1.9% to 72%, although the prevalence in most studies was between 20% and 60% (n=9). Conclusions: Although decisional conflict is widely assessed in primary care, very few studies report the prevalence of CSDC in their population. Further studies are needed to explore the epidemiology of CSDC in primary care and establish a clear threshold for CSDC.