FEASIBILITY OF IN-CLINIC VIEWING OF PATIENT DECISION AID VIDEOS

Purpose: To determine the feasibility of an in-clinic decision aid distribution process using a care assistant model for delivery.

Methods: We identified potentially eligible patients scheduled for upcoming appointments in the General Internal Medicine Clinic (N=2627). Patients were deemed eligible for two decision aids: prostate cancer screening (PSA) [men ages 49-70] and weight loss surgery (WLS) [body mass indexes ≥40 and insurance coverage]. A care assistant was charged solely with distributing decision aids to as many eligible patients as possible, generally before their appointments. For 81 days over a 5-month period the care assistant tracked the number of potentially eligible patients and whether they completed the target decision aid. The PSA and WLS decision aids were 32 and 37 minutes, respectively. The decision aids were viewed during unoccupied time during clinic visits on a portable DVD player.

Results: Of the 1229 patients with a scheduled appointment, 725 attended. Of the 725 who attended the care assistant approached 499 (69%) of those patients.  Of the 499 approached, 402 (81%) remained eligible after additional review. 265 (66%) viewed at least a portion of the target decision aid [226 of 343 (66%) viewed PSA and 39 of 59 (66%) viewed WLS].  A greater percentage completed viewing the WLS than PSA decision aid [22 (56%) versus 72 (32%)]. The mean time of viewing for patients who watched less than the complete decision aid was 13 minutes, and did not differ between decision aid-type. 41% of patients viewed the decision aid only in the exam room, 13% viewed it solely in the waiting room, and the majority (46%) of patients viewed the decision aid in both locations.

Conclusions: Our findings suggest that in-clinic viewing of decision aids is a feasible distribution method for decision aids, but may not be the most effective method for complete viewing. Shorter decision aids may result in a greater complete viewing, but may not impart the same amount of information to patients. These findings should be compared to other methods of distribution, including a pre-visit mail out associated with a future visit to further our understanding of effective decision aid distribution.