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Tuesday, October 21, 2008
Columbus A-C (Hyatt Regency Penns Landing)
PURPOSE: To understand patient experiences with selecting pain medications for osteoarthritis (OA), and to elicit their preferences and priorities regarding the content and format of a computer-based, interactive aid to assist those decisions.
METHODS: A two-phase, mixed methods process was used. In the first phase (presented here), we developed a template for the decision aid based on literature review and a focus group with five OA patients in Rochester, NY. In the second phase, we used structured items to educe patient responses to our decision dashboard, and open-ended questions to determine which aspects of the decision tool were most/least useful to patients and why, and what, if at all, should be altered for a final version of the aid.
FINDINGS: Patients with OA utilize myriad sources (i.e., physicians, family members, friends, internet) in learning and making decisions about how to manage associated pain. They also have a range of priorities and concerns which inform those efforts, including principally desires for: timely pain relief, maximum mobility and functionality, and sound sleep. While participants were concerned about possible medication side effects (primarily about cardiac events, but also gastrointestinal bleeding), they balance those against the risk of remaining in pain and thus unable to live well. They expressed uncertainty about how to evaluate numerical estimations of risk (especially small ones), such that desire for pain relief generally trumps concerns about (what can appear to be minimal) medication risks. Participants reported being concerned, however, about drug interactions. They also want to know more about how and when to take medications, and how to time pain medications relative to others they take. Regarding the decision tool itself, patients varied considerably in terms of how much information they desire, with some wanting minimal and other extensive amounts. They also varied in how they would like information presented, with some preferring a more narrative and qualitative presentation of information, and others a graphic or visual display.
CONCLUSIONS: Participants reported various information needs regarding medications for OA pain, as well as preferences regarding how such information should be delivered. A decision aid capable of presenting different kinds and amounts of information, and in variable formats based on patient desire, would be optimal for responding to patients’ diverse concerns and capabilities.
METHODS: A two-phase, mixed methods process was used. In the first phase (presented here), we developed a template for the decision aid based on literature review and a focus group with five OA patients in Rochester, NY. In the second phase, we used structured items to educe patient responses to our decision dashboard, and open-ended questions to determine which aspects of the decision tool were most/least useful to patients and why, and what, if at all, should be altered for a final version of the aid.
FINDINGS: Patients with OA utilize myriad sources (i.e., physicians, family members, friends, internet) in learning and making decisions about how to manage associated pain. They also have a range of priorities and concerns which inform those efforts, including principally desires for: timely pain relief, maximum mobility and functionality, and sound sleep. While participants were concerned about possible medication side effects (primarily about cardiac events, but also gastrointestinal bleeding), they balance those against the risk of remaining in pain and thus unable to live well. They expressed uncertainty about how to evaluate numerical estimations of risk (especially small ones), such that desire for pain relief generally trumps concerns about (what can appear to be minimal) medication risks. Participants reported being concerned, however, about drug interactions. They also want to know more about how and when to take medications, and how to time pain medications relative to others they take. Regarding the decision tool itself, patients varied considerably in terms of how much information they desire, with some wanting minimal and other extensive amounts. They also varied in how they would like information presented, with some preferring a more narrative and qualitative presentation of information, and others a graphic or visual display.
CONCLUSIONS: Participants reported various information needs regarding medications for OA pain, as well as preferences regarding how such information should be delivered. A decision aid capable of presenting different kinds and amounts of information, and in variable formats based on patient desire, would be optimal for responding to patients’ diverse concerns and capabilities.
See more of: Poster Session IV
See more of: 30th Annual Meeting of the Society for Medical Decision Making (October 19-22, 2008)