Methods: DAs were distributed by the Center for Shared Decision Making at Dartmouth Hitchcock Medical Center from January 2004 through December 2005. The sample represents patients referred for decision support including the distribution of DAs as part of routine care. A semi-structured qualitative interview guide was used to conduct telephone debriefing calls approximately one month after viewing the DA.
Results: A convenience sample of 245 patients who received care for back pain (79), breast cancer (62), hip/knee osteoarthritis (38), prostate conditions (27), coronary artery disease (24), OB/Gyn conditions (15) participated. The mean age was 58 and 61% were female. Participants tended to view the DA more than once (mean 1.4) and 64% watched with someone else (e.g. spouse or family member). Patients were more likely to have a treatment preference after watching the video (64% before vs. 85% after, Chi-sq=30, p < .0001). For patients who indicated the DA affected their decision (n=129), 64% said the video reinforced their decision while 24% changed their mind. The most useful aspects of the videos was the information presented (41%) and patient testimonials (24%). For breast reconstruction patients, the pictures of the surgery (39%) were most useful. A minority of patients preferred a format they could view on a computer (11%). Three-quarters of participants felt that they viewed the DA at the right time, while 17% wished they watched it earlier. At the time of the interview, only 38% of patients had a follow-up discussion about the information with their physicians.
Conclusions: The information and testimonials presented in these decision aids influenced patient decision making. DAs given after a clinical appointment may help to clarify the decision, but do not regularly prompt discussions with the patients' physicians. To encourage patient-physician conversations about medical decisions, further study to assess appropriate timing of DAs is warranted.