Defense Date


Graduation Date



Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Gladys L. Husted

Committee Member

Charles T. Rubin

Committee Member

Joan Such Lockhart


bioethics, decision support intervention, ethical decision-making, health care decision-making, theory testing


This study tested the theory of Symphonology in two ways: 1) by determining if concepts in Symphonology were expressed in the experience of patients involved in health care decision-making, and 2) by testing the effect of an education/counseling intervention based on Symphonology, designed to facilitate decision-making. The study design was a pre-test post-test quasi-experimental design. Demographic and disease-related variables, decision-making role preference and the Bioethical Decision Making Preference Scale for Patients/Families (BDMPSP) (Husted, 2001) were measured prior to the intervention. Demographic variables that were measured included age, gender, race, marital status, years and type of education and time since diagnosis. Verbatim transcripts of semi-structured subject interviews were analyzed. The intervention provided was designed to assist subjects through the decision-making process using Symphonology. After the intervention subjects were again interviewed and they completed a post-test BDMPSP. Subject responses from post-test interviews were triangulated with results of statistical analysis testing the difference between pre and post-intervention BDMPSP scores. Relationships between demographic variables and decision-making role preference and BDMPSP scores were statistically analyzed.

The sample consisted of 30 subjects involved in a variety of decisions about health care and treatment during hospitalization in an acute care setting. Median age was 63, 75.7% were female (n = 23) and 53.3% (n = 16) had greater than a high school education. The distribution of decision-making role preferences was 40% active, 53.3% collaborative, and 6.7% passive. There were no significant relationships between demographic variables and decision-making role preference. Qualitative analysis demonstrated that patients expressed all of the concepts of Symphonology in interviews. Statistical analysis of differences in pre and post BDMPSP scores demonstrated that subjects had a more positive experience of being involved in decision-making (p = .02), felt more sufficiency of knowledge (p = .013), less frustration (p = .014) and more powerful (p = .009) after the intervention. Quantitative results were supported by qualitative findings. Findings support the validity of Symphonology theory. The theory can be used to describe the experience of being involved in decision-making and Symphonology has utility as a model for assisting patients through the decision-making process.