CP-021 The impact of a decision aid on depressed patient’s involvement in shared decision making: A pilot randomised controlled double blind study

2016 ◽  
Vol 23 (Suppl 1) ◽  
pp. A9.3-A10 ◽  
Author(s):  
K Aljumah ◽  
A Nwaf ◽  
A Amed ◽  
A Alhoutan ◽  
M Aldhiab
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Blind Study ◽  
Double Blind Study ◽  
Shared Decision ◽  
Double Blind ◽  
Randomised Controlled ◽  
The Impact

Abstract 27: Patients' Perspectives on a Decision Aid to Facilitate Cost-sensitive Decisions for Sacubitril-Valsartan

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andrea R Mitchell ◽  
Grace Venechuk ◽  
Larry A Allen ◽  
Dan D Matlock ◽  
Miranda Moore ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Shared Decision ◽  
Cost Information ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: Decision aids frequently focus on decisions that are preference-sensitive due to an absence of superior medical option or qualitative differences in treatments. Out of pocket cost can also make decisions preference-sensitive. However, cost is infrequently discussed with patients, and cost has not typically been considered in developing approaches to shared decision-making or decision aids. Determining a therapy’s value to a patient requires an individualized assessment of both benefits and cost. A decision aid addressing cost for sacubitril-valsartan in heart failure with reduced ejection fraction (HFrEF) was developed because this medication has clear medical benefits but can entail appreciable out-of-pocket cost. Objective: To explore patients’ perspectives on a decision aid for sacubitril-valsartan in HFrEF. Methods: Twenty adults, ages 32-73, with HFrEF who met general eligibility for sacubitril-valsartan were recruited from outpatient HF clinics and inpatient services at 2 geographically-distinct academic health systems. In-depth interviews were conducted by trained interviewers using a semi-structured guide after patients reviewed the decision aid. Interviews were audio-recorded and transcribed; qualitative descriptive analysis was conducted using a template analytic method. Results: Participants confirmed that cost was relevant to this decision and that cost discussions with clinicians are infrequent but welcomed. Participants cited multiple ways that this decision aid could be helpful beyond informing a choice; these included serving as a conversation starter, helping inform questions, and serving as a reference later. The decision aid seemed balanced; several participants felt that it was promotional, while others wanted a more “positive” presentation. Participants valued the display of benefits of sacubitril-valsartan but had variable views about how to apply data to themselves and heterogenous interpretations of a 3% absolute reduction in mortality over 2 years. None felt this benefit was overwhelming; about half felt it was very small. The decision aid incorporated a novel “gist statement” to contextualize benefits and counter tendencies to dismiss this mortality reduction as trivial. Several participants liked this statement; few had strong impressions. Conclusion: Out of pocket cost should be part of shared decision-making. These data suggest patients are receptive to inclusion of cost in decision aids and that a “middle ground” between being promotional and negative may exist. The data, however, raise concerns regarding potential dismissal of clinically meaningful benefits and illustrate challenges identifying appropriate contextualizing language. The impact of various framings warrants further study, as does integration of decision aids with patient-specific out-of-pocket cost information during clinical encounters.

scholarly journals Head to head randomized trial of two decision aids for prostate cancer

2019 ◽  
Author(s):  
Angela Fagerlin ◽  
Margaret Holmes-Rovner ◽  
Timothy P. Hofer ◽  
David Rovner ◽  
Stewart C. Alexander ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Physician Visit ◽  
Treatment Preference ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Centered ◽  
Standard Language ◽  
The Impact

Purpose: While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DA affect key outcomes such as treatment choice, patient-provider communication, or decision process/satisfaction. This study tested the impact of a typical medical oriented DA compared to a patient centered decision aid designed to encourage shared decision making and the decision making process in men with clinically localized prostate cancer.Patients and Methods: 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a patient centered or standard language DA. Participants were men with clinically localized cancer (N = 285) by biopsy and whom completed pre-clinic surveys. Survey measures: baseline (Time 1); immediately prior to seeing the physician for biopsy results (Time 2); one week following the physician visit (Time 3). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA.Results: Participants who received the patient centered DA had greater interest in shared decision making after reading the DA (p=0.03), found the DA more helpful (p’s<0.01) and were more likely to be considering surveillance (p=0.03) compared to those receiving the standard language DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received.Conclusions: The patient centered DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences.

scholarly journals The Impact of a Novel Computer-Based Decision Aid on Shared Decision Making for Colorectal Cancer Screening

2010 ◽  
Vol 31 (1) ◽  
pp. 93-107 ◽  
Author(s):  
Paul C. Schroy ◽  
Karen Emmons ◽  
Ellen Peters ◽  
Julie T. Glick ◽  
Patricia A. Robinson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Colorectal Cancer Screening ◽  
Decision Aid ◽  
Shared Decision ◽  
Computer Based ◽  
The Impact

scholarly journals Head to head randomized trial of two decision aids for prostate cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Fagerlin ◽  
Margaret Holmes-Rovner ◽  
Timothy P. Hofer ◽  
David Rovner ◽  
Stewart C. Alexander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Physician Visit ◽  
Treatment Preference ◽  
Baseline Survey ◽  
Treatment Preferences ◽  
Shared Decision ◽  
The Impact

Abstract Background While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer. Methods 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA. Results Participants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received. Conclusions The simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences. Trial registration This trial was pre-registered prior to recruitment of participants.

Abstract 202: A Pilot Study to Evaluate the Impact of Decision Aid Timing on Mandatory Shared Decision Making for Defibrillator Implantation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Birju Rao ◽  
Neal W Dickert ◽  
David Howard ◽  
Dan D Matlock ◽  
Leon Darghosian ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Implementation Strategy ◽  
Office Visit ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Icd Implantation ◽  
The Impact ◽  
To Receive

Background: In 2018, CMS required shared decision-making (SDM) with a decision (DA) prior to implantation of a primary prevention cardioverter defibrillator (ICD). Little is known about how DAs should be incorporated, but the implementation strategy may affect the process. Providing DAs prior to the SDM visit may facilitate informed discussion. However, this requires identifying ICD candidates ahead of time which may be logistically challenging. Providing the DA during the office visit requires less administrative effort but may reduce the impact of the DA. Objective: To evaluate the impact of DA timing on SDM outcomes. Methods: Patients referred for ICD implantation were block randomized across 3 clinics to receive the DA 30 minutes prior to, or at the end of the SDM visit. Patients were surveyed on implant day in several SDM domains including knowledge about ICDs, decisional conflict, values-choice concordance and the extent to which patients felt engaged in the decision-making process. Patients who chose not to have an ICD implanted after the SDM visit were surveyed by mail. Implanting physicians were also surveyed to assess perceptions about the impact of the DA. Results: Of 42 randomized patients, 24 completed the survey with 9 who received the DA before and 15 after the SDM visit. Three chose not to have an ICD implanted: 1 received the DA before and 2 after the visit. Though overall knowledge about ICDs was similar between groups (Table), every patient who received the DA before the encounter understood the primary purpose of the ICD, compared with 10/15 who received the DA after the visit. Receiving the DA earlier showed a numerically higher rate of understanding the risk of inappropriate ICD shocks. No significant differences were observed in decisional conflict, values-choice concordance, or reported patient engagement in decision-making. Conclusion: Patients who received a DA prior to the visit had numerically, but not significantly, higher rates of understanding the purpose of the ICD and risk of inappropriate shocks. These pilot data suggest that efforts to provide DAs ahead of time may strengthen SDM interaction and that an implementation strategy is critical to study. Important knowledge gaps remain in both groups, suggesting opportunities to improve SDM for ICDs.

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