Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II

Abstract

PurposeOsteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient’s estimated risk of fracture using the FRAX calculator is unknown.MethodsPatient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.ResultsWe enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01), improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively), had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001). Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer). There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07); medication adherence at 6 months was no different across arms.ConclusionSupporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.Trial Registrationclinical trials.gov NCT00949611

Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

“…Three studies assessed helpfulness of the information in the intervention and control group. Results from all studies indicated that clinicians found the information in the decision aid group more helpful than in the control (mean difference 0.64, 95% CI 0.18 to 1.0927 (table 2); 70% vs 35% of clinicians judged information as helpful26 and a significantly higher proportion (54.1%) of clinicians in the intervention group who judged the information as extremely helpful compared with the control (33.7%) (figure 2). 15…”

“…Twenty-five papers met the inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials (online supplementary file 1). 13–37 One study was excluded because it had no comparator group without decision aid 38. There were three nested qualitative studies and nine RCTs included in our review that were not included in the Cochrane review, the majority of which were published after April 2015, the date of the literature search for the Cochrane review.…”

Understanding patients’ preferences for osteoporosis treatment: the impact of patients’ characteristics on subgroups and latent classes

“…The FRAX (Fracture Risk Assessment Tool) score was also not incorporated in the analysis due to the absence of data. Knowledge of the risk of a new fracture could potentially influence patient preferences [36].…”

Humor During Clinical Practice: Analysis of Recorded Clinical Encounters

“…[17][18][19][20][21][22][23] Recordings were audiovisual or audio-only based on the preferences of the patients and their clinicians at the time of enrollment. Of the 272 complete videos available for analyses from these trials, we included all the videos that were recorded in specialty care (51) and selected a random sample of 61 videos from the 221 remaining primary care videos stratified by treatment arm (decision aid use) to complete a sample of 112 videos.…”