Purpose: The purpose of this study was to design, develop and evaluate the feasibility of a web-based decision support system for studies that 1) investigate the effectiveness of components of patients’ decision aids (PtDAs), and 2) observe the “black box” of diverse patients’ information-processing and deliberation.
Method: Clinical content was derived from literature review and reviewed by expert panel. Decision support content was based on the Ottawa Decision Support Framework in accordance with the International Patient Decision Aids Standards. The research website was developed using a Digital Decision Support Developer. Prototypes were reviewed by clinicians, decision support specialists and orthopedic patients. Two PtDA versions were created. The “Information-Provision” version provides clinical information about the risks/benefits of treatment options for surgical/nonsurgical management of osteoarthritis knee pain, with “More Information” links for greater detail on key topics. The “Information+Deliberation” version presents the same high-quality clinical information, followed by guidance through four theory-based Deliberative Steps, with optional interactive activities provided at each Step. The website tracks the topics for which greater detail is viewed and engagement at each Step. Both versions collect pre-PtDA levels of decisional conflict, patient characteristics and initial strength of treatment preference, as well as post-PtDA measures of information comprehension, preparation for decision making, decision self-efficacy, decisional conflict and final strength of treatment preference. 12 patients with osteoarthritis of the knee were randomized to review one version of the website (n=6 per group). Feasibility as a research tool was assessed in terms of patients’ objective comprehension of the clinical information and subjective ratings of clarity, length, ease of use, amount of information and ability to hold interest.
Result: Both groups scored >70% correct on the 5 information objective comprehension items (range: 70-80%) and provided >85% positive ratings on the 5 feasibility items (range: 67-100%). Viewing either version reinforced strength of treatment preference without affecting decisional conflict (range: 13-32, change: 1-14 points). Participants spent 15-45 minutes viewing the material, including selecting a variety of additional detail and engagement activities.
Conclusion: Results indicate that a web-based decision support system may be a feasible platform for conducting investigative research. Ongoing research into the effect of explicit deliberative support on preparation for decision making and variations by patient subgroup may direct the future design of customizable decision support tools.
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