Purpose Engaging patients in high quality decision making testing and treatment choices for chronic conditions during office visits is challenging, especially in primary care. Although decision aids (DAs) have been shown to be effective tools in improving patient decision making, there has not been widespread and routine use in clinical settings and their impact on decision quality has not been established. The goals of this study were two-fold: 1) assess feasibility of integrating chronic condition DAs into routine process of primary care practice, and 2) assess DAs' impact on patient decision making.

Methods Seventeen chronic condition video DAs were made available for clinicians to prescribe to eligible patients at two academic general internal medicine practices. Patients viewing the DAs were asked to: 1) complete a pre-DA questionnaire, 2) watch the DA and 3) complete a post-DA questionnaire. Measures: treatment intention, values influencing the decision, knowledge and DA acceptability. At the time of this abstract, clinicians have prescribed 12/17 DAs addressing decisions for the following conditions: Benign Prostatic Hypertrophy (BPH), Knee Osteoarthritis, Advanced Directives, Depression, Congestive Heart Failure, Chronic Low Back Pain, Herniated Disc, Weight Loss Surgery, Spinal Stenosis, Hip Osteoarthritis, Acute Low Back Pain, and Menopause.

Results During the first 5 months of the 18 month study: clinicians have prescribed 73 DAs to patients. Nineteen patients have returned questionnaires to date. Treatment choices for BPH (n=19) was the most frequently prescribed DA followed by knee osteoarthritis (n=11). After watching the DA, • A substantial number of patients changed their treatment intention (37%). • Patients knew benefits and risks associated with their decision (89%), and were clear about their personal values (95%). • Most patients (57%) planned to talk with their health care provider about their decision after viewing the DA. • Patients felt the information presented by the DA was the appropriate amount (88%) and unbiased (83%). • Patients would recommend the DA to others facing the same decision (100%).

Conclusions Prescription of chronic condition DAs for patients in primary care practice is feasible. After watching these DAs, patients felt informed, clear about their values, prepared to make treatment decision and rated the DAs highly. Early indications suggest chronic condition DAs are effective and acceptable tools to facilitate decision making in primary care.