Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences

Scalia, Peter; Durand, Marie-Anne; Kremer, J.A.M.; Faber, Marjan J.; Elwyn, Glyn

doi:10.1177/0272989x17734538

Cited by 19 publications

(13 citation statements)

References 16 publications

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“…Our previous work indicated that FAQs 1, 3, and 8 shifted user preferences to not having the PSA screening test. In this study, FAQs 1, 3, and 7 shifted preference in the same direction, confirming that risk information (FAQs 7 and 8 both discuss risk) may be the active ingredient in the PSA Option Grid responsible for the shift [9]. FAQs 7 and 8 discuss the risk of the PSA test and the risk of the prostate biopsy, respectively.…”

Section: Discussionsupporting

confidence: 75%

“…The FAQs represented nominal independent variables and were inserted as factors in the model. Due to the fact that multiple treatment options are being compared for each FAQ, we decided that FAQs with a P value of ≤.02 would be considered statistically significant in terms of shifting user preference [9].…”

Section: Methodsmentioning

confidence: 99%

“…The tool assesses user knowledge, level of decisional conflict, and preference before and after viewing the information. A prior study among 82 participants shows that users of the PSA Option Grid tend to become more risk averse, shifting their preference to “not having the test” after viewing risk information associated with the screening test and prostate biopsies [9]. This indicates a real-world impact on screening preference for users who spontaneously use this tool [9].…”

Section: Introductionmentioning

confidence: 99%

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Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid

Scalia¹,

Elwyn²,

Kremer³

et al. 2018

JMIR Cancer

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BackgroundRandomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet.ObjectiveThe objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes.MethodsData were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference.ResultsOf all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift.ConclusionsUnprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.

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Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid

Scalia¹,

Elwyn²,

Kremer³

et al. 2018

JMIR Cancer

Self Cite

View full text Add to dashboard Cite

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“…The whole of the ‘Dialysis Choice’ PDA contributed to the decision-making process, but the patients identified the overview of options and the value clarification tool as being particularly helpful. An Option Grid is a specific type of overview of options, and research has shown that, for some health decisions, an Option Grid supports patients in the decision-making process 45. From a healthcare perspective, the Option Grid has been found to be easy to use to facilitate patient involvement in the decision-making process 46.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a shared decision-making intervention for dialysis choice at four Danish hospitals: a qualitative study of patient perspective

2019

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ObjectiveTo evaluate the ‘Shared Decision-making and Dialysis Choice’ (SDM-DC) intervention with regard to patients’ experience and involvement.DesignSemistructured individual interviews and systematic text condensation for data analysis.SettingThe SDM-DC intervention was implemented and evaluated at four different hospitals in Denmark.ParticipantsA total of 348 patients had received the SDM-DC intervention, and of these 29 patients were interviewed.InterventionsSDM-DC was designed for patients facing a choice of dialysis modality. The available modalities were haemodialysis and peritoneal dialysis, either performed by patients on their own or with help from a healthcare professional. The intervention was tailored to individual patients and consisted of three meetings with a dialysis coordinator who introduced a patient decision aid named ‘Dialysis Choice’ to the patient.FindingsThe following were the four main findings: the decision was experienced as being the patient’s own; the meetings contributed to the decision process; ‘Dialysis Choice’ contributed to the decision process; and the decision process was experienced as being iterative.ConclusionsThe patients experienced SDM-DC as involving them in their choice of dialysis modality. Due to the iterative properties of the decision-making process, a shared decision-making intervention for dialysis choice has to be adapted to the needs of individual patients. The active mechanisms of the meetings with the dialysis coordinator were (1) questions to and from the patient, and (2) the dialysis coordinator providing accurate information about the options. The overview of options and the value clarification tool in the decision aid were particularly helpful in establishing a decision-making process based on informed preferences.

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“…This decision aid shifts user preferences regarding treatment, but improvements in satisfaction or adherence have not been documented. 27 Both of these decision aids focus on whether to take statins and do not provide information on the comparative effects of statins and patients’ preferences regarding these benefits and harms. The interactive tool evaluated in this study is therefore novel in combining the results of published network meta-analyses with user preferences.…”

Section: Discussionmentioning

confidence: 99%

Combining Multiple Treatment Comparisons with Personalized Patient Preferences: A Randomized Trial of an Interactive Platform for Statin Treatment Selection

Hopkin

Collier

et al. 2019

Med Decis Making

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Background. Patients and clinicians are often required to make tradeoffs between the relative benefits and harms of multiple treatment options. Combining network meta-analysis results with user preferences can be useful when choosing among several treatment alternatives. Objective. Using cholesterol-lowering statin drugs as a case study, we aimed to determine whether an interactive web-based platform that combines network meta-analysis findings with patient preferences had an effect on the decision-making process in a general population sample. Method. This was a pilot parallel randomized controlled trial. We used Amazon’s Mechanical Turk to recruit adults residing in the United States. A total of 349 participants were randomly allocated to view either the interactive tool (intervention) or a series of bar charts (control). The primary endpoint was decisional conflict, and secondary endpoints included decision self-efficacy, preparation for decision making, and the overall ranking of statins. Results. A total of 258 participants completed the trial and were included in the analysis. On the primary outcome, participants randomized to the interactive tool had significantly lower levels of decisional conflict than those in the control group (difference, –8.53; 95% confidence interval [CI], −12.96 to −4.11 on a 100-point scale; P = 0.001). They also appeared to have higher levels of preparation for decision making (difference, 4.19; 95% CI, –0.24 to 8.63 on a 100-point scale; P = 0.031). No difference was found for decision self-efficacy, although groups were statistically significantly different in how they ranked different statins. Conclusion. The findings of our proof-of-concept evaluation suggest that an interactive web-based tool combining published clinical evidence with individual preferences can reduce decisional conflict and better prepare individuals for decision making.

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Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences

Abstract: The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

Cited by 19 publications

References 16 publications

Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid

Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid

Evaluation of a shared decision-making intervention for dialysis choice at four Danish hospitals: a qualitative study of patient perspective

Combining Multiple Treatment Comparisons with Personalized Patient Preferences: A Randomized Trial of an Interactive Platform for Statin Treatment Selection

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