“Is it time to stop driving?”: A randomized clinical trial of an online decision aid for older drivers

Abstract

Background Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. Methods This prospective two‐arm randomized trial enrolled English‐speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing “Is it time to stop driving?”; control was web‐based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self‐efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed‐effects models with adjustment for site and prerandomization scores. Results Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non‐Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61–0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01–1.27, p = 0.038); there was no difference between groups in self‐efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations. Conclusions The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English‐speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility. Trial registration http://clinicaltrials.gov identifier “Advancing Understanding of Transportation Options (AUTO)” NCT04141891.

Relationship of Decisional Conflict About Driving Habits Between Older Adult Drivers and Their Family Members and Close Friends

“…The DCS is a 16-item scale assessing the decision quality, internal conflict, and values concordance towards a medical decision (O’Connor, 1993; O’Connor, 1995). For the AUTO study, we modified the DCS to assess the decision quality of study partner’s decision whether the driver should stop or continue driving (Betz et al, 2021, 2022). The DCS has a test-retest correlation of .81, with internal consistency ranging between .78 and .92 (O’Connor, 1995).…”

“…Data for this analysis uses data from the Advancing Understanding of Transportation Options (AUTO) study, a multi-site, two-armed randomized controlled trial testing the efficacy of the driving decision aid ((Healthwise, 2016) for older adult drivers and their study partner, which included family members and friends (Betz et al, 2021, 2022). We found that the decision aid decreased decisional conflict and increased driving knowledge in older adult drivers (Betz et al, 2022). Prior analyses of the impact of the decision aid did not evaluate its influence on the study partner’s decisional conflict or how their decisional conflict was associated with the driver’s.…”