Purpose: Choices are known to be informed by, and adapt to, the way information is presented and while patient decision aids are developed in as balanced manner as possible, some bias is unavoidable. We sought to utilize ‘nudge’ thinking to develop an application that presents information from conventional decision aids in such a way that choices are more congruent with the patient’s own values.
Method: The application works by beginning with an interactive value clarification task which dynamically changes the way subsequent information is presented. Three decision aids (from osteoarthritis, non-small cell lung cancer and obstructive sleep apnea) were converted to the DCIDA for the purposes of preliminary testing. We sought feedback from 12 experts in decision aids, web tool development, and patient decision making to assess the feasibility of the approach and gain initial feedback. A modified version was then tested for its usability in 16 lay people. Users were first asked to choose between options using a conventional decision aid, and then were subsequently asked to use the DCIDA version. Usability was evaluated using: a) eye-tracking, to determine what information users were spending time examining, b) a hybrid concurrent and retrospective ‘think aloud’ study, and c) the system usability scale (SUS).
Results: The predominant feedback from experts was a perceived difficulty for some users in understanding the tasks required to move through the application. The modified version included an interactive guide to help coach users through this process. The mean SUS score was 84 (SD=22), indicating a high degree of usability. The key theme identified in the ‘think aloud’ study supported results from eye-tracking – that when using DCIDA, subjects focused more on the features of the decision that were most important to them (21% increase in time spent focusing on the most important feature). This appeared to lead to 4 (25%) subjects changing their decision when using DCIDA- each time to the option that appeared to be more consistent with their stated values.
Conclusion: Preliminary results suggest that DCIDA has considerable potential to enhance the quality of patient decision-making. Further evaluation is required to explore more definitively whether it can overcome some of the ethical concerns with presentation of information in decision aids.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making