scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

scholarly journals Web-based decision aid tool for disclosure of a mental health condition in the workplace: a randomised controlled trial

2019 ◽  
Vol 76 (9) ◽  
pp. 595-602 ◽  
Author(s):  
Elizabeth Stratton ◽  
Isabella Choi ◽  
Rafael calvo ◽  
Ian Hickie ◽  
Claire Henderson ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Depressive Symptoms ◽  
Randomised Controlled Trial ◽  
Decision Aid ◽  
Controlled Trial ◽  
Decisional Conflict ◽  
Web Based ◽  
Randomised Controlled

ObjectivesMaking decisions about disclosing a mental illness in the workplace is complicated. Decision aid tools are designed to help an individual make a specific choice. We developed a web-based decision aid to help inform decisions about disclosure for employees. This study aimed to examine the efficacy of this tool.MethodWe conducted a randomised controlled trial with recruitment, randomisation and data collection all online. Participants had access to the intervention for 2 weeks. Assessments occurred at baseline, postintervention and 6 weeks’ follow-up. The primary outcome was decisional conflict. Secondary outcomes were stage and satisfaction of decision-making and mental health symptoms.Results107 adult employees were randomised to READY (n=53) or the control (n=54). The sample was predominantly female (83.2%). Participants using READY showed greater reduction in decisional conflict at postintervention (F(1,104)=16.8, p<0.001) (d=0.49, 95% CI 0.1 to 0.9) and follow-up (F(1,104)=23.6, p<0.001) (d=0.61, 95% CI 0.1 to 0.9). At postintervention the READY group were at a later stage of decision-making (F(1,104)=6.9, p=0.010) which was sustained, and showed a greater reduction in depressive symptoms (F(1,104)=6.5, p=0.013). Twenty-eight per cent of READY users disclosed, and reported a greater improvement in mental health than those who did not disclose.ConclusionsREADY provides a confidential, flexible and effective tool to enhance employee’s decision-making about disclosure. Its use led to a comparative improvement in depressive symptoms compared with the current information provided by a leading mental health non-governmental organisation, without apparent harm. READY seems worth evaluating in other settings and, if these results are replicated, scaling for wider use.Trial registration numberACTRN12618000229279.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations

2018 ◽  
Vol 42 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Matthew Quigley ◽  
Michael P Dillon ◽  
Stefania Fatone
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Development Process ◽  
Decision Aids ◽  
Treatment Options ◽  
International Standards ◽  
Shared Decision ◽  
Patient Decision ◽  
Partial Foot Amputation

Background: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. Objectives: To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Conclusion: Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

scholarly journals Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial

2013 ◽  
Vol 203 (5) ◽  
pp. 350-357 ◽  
Author(s):  
Claire Henderson ◽  
Elaine Brohan ◽  
Sarah Clement ◽  
Paul Williams ◽  
Francesca Lassman ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Usual Care ◽  
Decision Aid ◽  
Controlled Trial ◽  
Intervention Group ◽  
Decisional Conflict ◽  
Full Time ◽  
Randomised Controlled

BackgroundMany mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request ‘reasonable adjustments’. There have been no intervention studies to support decisionmaking about disclosure to an employer.AimsTo determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid.MethodIn this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014).ResultsWe recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement −22.7 (s.d. = 15.2) v. −11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03).ConclusionsThe observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.

Supporting Treatment Decision Making in Advanced Cancer: A Randomized Trial of a Decision Aid for Patients With Advanced Colorectal Cancer Considering Chemotherapy

2011 ◽  
Vol 29 (15) ◽  
pp. 2077-2084 ◽  
Author(s):  
Natasha B. Leighl ◽  
Heather L. Shepherd ◽  
Phyllis N. Butow ◽  
Stephen J. Clarke ◽  
Margaret McJannett ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Randomized Trial ◽  
Advanced Cancer ◽  
Decision Aid ◽  
Advanced Colorectal Cancer ◽  
Treatment Options ◽  
Decisional Conflict ◽  
First Line ◽  
Line Chemotherapy

Purpose Decision making in advanced cancer is increasingly complex. We developed a decision aid (DA) for patients with advanced colorectal cancer who are considering first-line chemotherapy and reviewing treatment options, prognostic information, and toxicities. We examined its impact on patient understanding, treatment decisions, decisional conflict, decision making, consultation satisfaction, anxiety, and quality of life by using a randomized trial design. Patients and Methods In all, 207 patients with colorectal cancer who were considering first-line chemotherapy for metastatic disease were randomly assigned to receive a standard medical oncology consultation or a consultation in which the DA (take-home booklet with audio recording, reviewed by an oncologist) was used. Participants completed questionnaires postconsultation, postdecision, and 1 month later. Results In this study, 100 patients were randomly assigned to the control arm, and 107 received the DA. Median age of the sample was 62 years, 58% were male, 89% had a performance status of 0 or 1, and 36% had received prior adjuvant chemotherapy. Patients receiving the DA demonstrated a greater increase in understanding of prognosis, options, and benefits, with higher overall understanding (P < .001). Decisional conflict, treatment decisions, and achievement of involvement preferences were similar between the groups. Anxiety was similar across groups and decreased over time. Most patients were confident in a decision during the first consultation; 74% chose chemotherapy, 7% supportive care alone, and 10% observation. Conclusion This randomized trial of a decision aid in advanced cancer showed that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. DAs can improve informed consent and can be tested through randomized trials even in the advanced cancer setting.

scholarly journals Evaluation of a Video Decision Aid to Reduce Decisional Conflict in Physician Orders for Life-Sustaining Treatment (POLST) Decision-Making

2020 ◽  
Vol 35 (4) ◽  
pp. 243-247
Author(s):  
Jarred V. Gallegos ◽  
Barry Edelstein ◽  
Alvin H. Moss
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Decision Aid ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Community Dwelling ◽  
Care Planning ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
Decisional Satisfaction

Background/Objectives: Physician Orders for Life-Sustaining Treatment (POLST) is recommended as a preferred practice for advance care planning with seriously ill patients. Decision aids can assist patients in advance care planning, but there are limited studies on their use for POLST decisions. We hypothesized that after viewing a POLST video, decision aid participants would demonstrate increased knowledge and satisfaction and decreased decisional conflict. Design: Pre-and postintervention with no control group. Setting/Participants: Fifty community-dwelling adults aged 65 and older asked to complete a POLST based on a hypothetical condition. Interventions: Video decision aid for Sections A and B of the POLST form. Measurements: Pre- and postintervention participant knowledge, decisional satisfaction, decisional conflict, and acceptability of video decision aid. Results: Use of the video decision aid increased knowledge scores from 11.24 ± 2.77 to 14.32 ± 2.89, P < .001, improved decisional satisfaction 10.14 ± 3.73 to 8.70 ± 3.00, P = .001, and decreased decisional conflict 12 ± 9.42 to 8.15 ± 9.13, P < .001. All participants reported that they were comfortable using the video decision aid, that they would recommend it to others, and that it clarified POLST decisions. Conclusions: Participants endorsed the use of a POLST video decision aid, which increased their knowledge of POLST form options and satisfaction with their decisions, and decreased their decisional conflict in POLST completion. This pilot study provides preliminary support for the use of video decision aids for POLST decision-making. Future research should evaluate a decision aid for the entire POLST form and identify patient preferences for implementing POLST decision aids into clinical practice.

scholarly journals Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review

Pain Medicine ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 951-969 ◽  
Author(s):  
Emily Bowen ◽  
Rabih Nayfe ◽  
Nathaniel Milburn ◽  
Helen Mayo ◽  
M C Reid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Musculoskeletal Pain ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Chronic Musculoskeletal Pain ◽  
Patient Decision Aids ◽  
Nonsurgical Management ◽  
Patient Decision

Abstract Objective To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. Methods We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. Results Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format. Conclusions Decision aids may improve patients’ knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.

scholarly journals Treatment decisions for patients with peripheral artery disease and symptoms of claudication: Development process and alpha testing of the SHOW-ME PAD decision aid

2021 ◽  
pp. 1358863X2098878
Author(s):  
Kim G Smolderen ◽  
Christina Pacheco ◽  
Jeremy Provance ◽  
Nancy Stone ◽  
Christine Fuss ◽  
...  
Keyword(s):  
Decision Making ◽  
Peripheral Artery Disease ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Medical Decision ◽  
Peripheral Artery ◽  
Invasive Treatment ◽  
Supervised Exercise ◽  
Artery Disease

Patients with peripheral artery disease (PAD) face a range of treatment options to improve survival and quality of life. An evidence-based shared decision-making tool (brochure, website, and recorded patient vignettes) for patients with new or worsening claudication symptoms was created using mixed methods and following the International Patient Decision Aids Standards (IPDAS) criteria. We reviewed literature and collected qualitative input from patients ( n = 28) and clinicians ( n = 34) to identify decisional needs, barriers, outcomes, knowledge, and preferences related to claudication treatment, along with input on implementation logistics from 59 patients and 27 clinicians. A prototype decision aid was developed and tested through a survey administered to 20 patients with PAD and 23 clinicians. Patients identified invasive treatment options (endovascular or surgical revascularization), non-invasive treatments (supervised exercise therapy, claudication medications), and combinations of these as key decisions. A total of 65% of clinicians thought the brochure would be useful for medical decision-making, an additional 30% with suggested improvements. For patients, those percentages were 75% and 25%, respectively. For the website, 76.5% of clinicians and 85.7% of patients thought it would be useful; an additional 17.6% of clinicians and 14.3% of patients thought it would be useful, with improvements. Suggestions were incorporated in the final version. The first prototype was well-received among patients and clinicians. The next step is to implement the tool in a PAD specialty care setting to evaluate its impact on patient knowledge, engagement, and decisional quality. ClinicalTrials.gov Identifier: NCT03190382

Decision Aids and Breast Cancer: Do They Influence Choice for Surgery and Knowledge of Treatment Options?

2007 ◽  
Vol 25 (9) ◽  
pp. 1067-1073 ◽  
Author(s):  
Jennifer F. Waljee ◽  
Mary A.M. Rogers ◽  
Amy K. Alderman
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Therapy ◽  
Early Stage ◽  
Decision Aids ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Decisional Conflict ◽  
Early Stage Breast Cancer ◽  
Patient Knowledge

Purpose To describe the effect of decision aids on the choice for surgery and knowledge of surgical therapy among women with early-stage breast cancer. Methods A systematic review was conducted between years 1966 to 2006 of all studies designed to assess the effect of decision aids on surgical therapy. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Network, HAPI databases, and bibliographies were searched. Of the 123 studies screened, 11 studies met criteria. Meta-analyses were performed to assess the pooled relative risk for surgical choice and the pooled mean difference in patient knowledge. Results Results from randomized controlled trials indicated that women who used a decision aid were 25% more likely to choose breast-conserving surgery over mastectomy (risk ratio, 1.25; 95% CI, 1.11 to 1.40). Decision aids significantly increased patient knowledge by 24% (P = .024). The data also suggested that decision aids decreased decisional conflict and increased satisfaction with the decision-making process. Decision aids were well received by surgeons and patients, facilitated patients’ desire for shared decision making, and were feasible to implement into practice. Conclusion Decision aids are important adjuncts for counseling women with early-stage breast cancer. Their use increases the likelihood that women will choose breast-conserving surgery, and enhances patient knowledge of treatment options.

When the goal is not cure: A randomized trial of a patient decision aid in advanced colorectal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6509-6509 ◽  
Author(s):  
N. B. Leighl ◽  
H. Shepherd ◽  
P. Butow ◽  
S. J. Clarke ◽  
M. McJannett ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Advanced Cancer ◽  
Decision Aid ◽  
Advanced Colorectal Cancer ◽  
Treatment Options ◽  
Decisional Conflict ◽  
Patient Understanding ◽  
To Receive

6509 Background: With improvements in treatment and supportive care, decisions in advanced cancer are increasingly complex. To facilitate decision-making, we developed a decision aid (DA) for patients considering first-line chemotherapy for incurable colorectal cancer, reviewing treatment options, prognostic information and toxicities. We examined its impact on patient understanding, consultation and decision- making satisfaction, anxiety, decisional conflict, quality of life, information preferences, and treatment decisions made. Methods: 207 newly diagnosed advanced colorectal cancer patients at 5 cancer centers in Australia and Canada were randomized to receive either a standard medical oncology consultation, or the same plus the DA, (take-home booklet with audio-recording, selected review by oncologist). Results: 100 were randomized to the control arm, 107 to receive the DA. Sample characteristics: median age 62 years, 58% male, 89% PS 0/1, 36% prior adjuvant chemotherapy. Patients in the DA arm demonstrated a greater increase in understanding of prognosis, options, benefits and toxicities (+19% vs +5.6%, p 0.001), with higher overall understanding (72% vs 60%, p<0.0001). Decision and consultation satisfaction, decisional conflict and quality of life were similar between groups. Anxiety, measured serially over 4–6 weeks, was similar and decreased over time. Most arrived at a decision during the first consultation; 80% chose chemotherapy, 7.5% supportive care alone, 10.5% a wait and watch strategy, with no differences between arms. 87% wanted as much information as possible, 82% wished to share decision-making with the physician, and only 15% felt the doctor alone should make the decision. More patients who received the decision aid felt they received all possible details about therapy, (72% vs 63%). 90% felt the decision was shared in part between physician and patient. Conclusion: This first randomized trial of a decision aid in advanced cancer patients shows that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks and benefits without increasing anxiety. Decision aids can improve informed consent and decision-making, and can be tested through randomized trials even in the setting of advanced cancer. No significant financial relationships to disclose.

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