ARE DECISION AIDS FOR EVERYONE? AN EXPLORATION OF THE RELATIONSHIP BETWEEN PATIENT DEMOGRAPHICS AND DECISION AID ACCEPTANCE

PURPOSE: To evaluate how patient demographics (sex, age, gender) relate to their reviews of video decision aids (DAs). DAs are becoming a valuable tool in clinical practice. They are used to clarify patients’ preferences and elicit their values regarding screening, treatment and management of various health conditions.

METHODS: Patients referred to the Center for Shared Decision Making at Dartmouth-Hitchcock Medical Center for decision support from July 2005 – November 2007 watched a decision-specific video DA and rated the program according to: length, overall impression, amount of information, clarity of information, helpfulness of content, and whether they would recommend the DA to others. Ratings were compared across sex, age, and education categories using Mann-Whitney U tests. Data were compared for 8 DAs on the following topics: breast reconstruction surgery (BCR), chronic low back pain (CLBP), herniated discs (HD), hip osteoarthritis (HOA), knee osteoarthritis (KOA), prostate cancer (PCA), prostate-specific antigen (PSA) testing, and spinal stenosis (SST).

RESULTS: Overall, patients gave high ratings to all DAs across all questions and within all demographic groups. DA ratings were not significantly different by sex, age, or education with a few exceptions. Sex: Women rated CLBP as too long more often than men (p = 0.001), and women were more likely than men to say that “everything” was clear in KOA (p = 0.002). Education: Patients with more education were more likely to rate the SST program as “too long” compared to those with less education (p = 0.005). Age: Younger patients wanted more information compared to older patients for both KOA (p = 0.003) and PCA (p = 0.004). They were more likely to rate SST as “all” or “mostly” clear compared to older patients (p = 0.005). Older patients thought HD was more helpful (p = 0.001) and better overall (p = 0.004) than younger patients.

CONCLUSION: Patients generally rate video DAs similarly regardless of their sex, age, or education. Intriguingly, the few cases of significant differences showed no tendency to fit with common assumptions that women are more interested in health information or that DAs are inappropriate for less educated or older people. Our findings support the appropriateness of broad dissemination of decision aids to patients regardless of age, sex, or education.