Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Effective patients’ decision aids (PtDAs) help patients understand clinical information and reduce decisional conflict. This study’s purpose was to test whether PtDAs that also explicitly provide guidance through four “deliberative steps” yield additional decision-making gains, and whether sub-groups of patients engage differently with the information and deliberative steps.
Method: We created two versions of a web-based PtDA regarding the surgical/nonsurgical management of chronic knee osteoarthritis. The Information-Provision version provided clinical information at an overview level (with optional “More Information” links to detail) and implicit deliberative guidance. The Information+Deliberation version provided the same clinical information and links, as well as explicit guidance through four deliberative steps: 1) information comprehension; 2) values clarification; 3) consideration of social resources; and 4) formation of an action plan. Each step offered an optional deliberative activity. In both versions, the program tracked selection of the information links; in the Information+Deliberation version, the program tracked engagement with the deliberative activities. Eligible participants (N = 126) were randomly assigned to one of the versions. Across-version analyses compared scores on self-reported post-PtDA Preparation for Decision Making, Decision Self-efficacy, and Decisional Conflict scales. Sub-groups using the “More Information” links and the deliberative activities were characterized.
Result: Across-Group Differences: There were no statistically significant across-version-group differences in mean Preparation for Decision Making, Decision Self-efficacy, or Decisional Conflict scores. In both groups (N = 126), 46% of participants engaged with the “More Information” links; they were primarily female, Caucasian, college-degreed, reported higher decisional conflict, and had viewed the Information+Deliberation version. In the Information+Deliberation group (n = 64), 43% engaged with the interactive deliberative activities. This sub-group was primarily female, Caucasian, college-educated, and reported higher levels of pain, higher decisional conflict scores, and greater familiarity with the decision. Across-Sub-groups: Increased engagement was significantly associated with increased self-efficacy (b = -9.08, p = 0.01) and decreased decisional conflict (b= -13.29, p = 0.007).
Conclusion: These results suggest that a) in chronic care, the effect of implicit versus explicit guidance may not vary, on average, b) sub-groups exist with differing “deliberative styles”, and c) some deliberative styles may benefit more from interactive features that provide personalized decision support.