5N-1 DEVELOPMENT AND PILOT OF FOUR DECISION AIDS FOR IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS IN DIFFERENT MEDIA FORMATS

Wednesday, October 21, 2015: 10:00 AM
Grand Ballroom B (Hyatt Regency St. Louis at the Arch)

Amy Jenkins, MS1, Jacqueline Jones, PhD, RN2, B. Karen Mellis1, Heather Nuanes3, Carolyn Nowels, MSPH4, Paul Varosy, MD5, Richard Thomson, MD6, Glyn Elwyn, MD, MSc, PhD7, David J. Magid, MD, MPH8, Angela Brega, PhD1, Travis Vermilye, MFA9, Fred Masoudi, MD, MSPH10 and Daniel Matlock, MD, MPH11, (1)University of Colorado, Denver, Aurora, CO, (2)University of Colorado College of Nursing, Aurora, CO, (3)Kaiser Permanente- Institute for Health Research, Denver, CO, (4)The University of Colorado Denver, Aurora, CO, (5)Denver Veterans Affairs Medical Center, Denver, CO, (6)University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom, (7)The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, (8)The Kaiser Institute for Health Research, Denver, CO, (9)University of Colorado, Denver, Denver, CO, (10)University of Colorado School of Medicine, Aurora, CO, (11)University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO
Purpose:  Develop and pilot four implantable cardioverter-defibrillator (ICD) decision aids for primary prevention.

Methods:   Tool development followed the Ottawa Decision Support Framework and the International Patient Decision Aid Standards. Prior qualitative and survey assessments directed the initial content. Decision aids (DAs) were iteratively modified using feedback from 28 patient interviews; three patient focus groups; patient stakeholders; local research groups; and a national panel of 14 experts in decision science and/or cardiovascular disease. The pilot trial was conducted at three clinics across Denver, Colorado. To test feasibility, recruitment strategies differed by site: 1) chart review of ICD referrals; 2) chart review of electrophysiologists’ (EP) schedules; and 3) clinic staff identification of eligible patients. Intervention patients were mailed the four DAs before discussing ICD therapy with the EP. Patients were interviewed at baseline, one month after meeting with the EP, and three months after enrollment. Primary outcomes were acceptability and feasibility; secondary outcomes included ICD-specific knowledge, decision quality, values concordance, decision conflict, and decision regret.

Results: Twenty-one eligible patients enrolled; 15 were randomized to the intervention and six to the control (usual care). 67% found the DAs to be unbiased, 22% thought they were biased toward ICDs, and 11% thought they were biased toward not getting an ICD. Furthermore, 89% found the DAs helpful and 100% would recommend them to others. The pilot was feasible at all sites; however, using clinic staff to identify eligible patients was more efficient than using chart review. Intervention patients did not have significantly greater knowledge about ICDs (M=14.00, SD=2.62) than controls (M=11.60, SD=3.13, t13=1.57, ns). Intervention patients had increased concordance between their decision and end-of-life values (71% concordant vs. 29%, p=0.06). Intervention patients did not have significantly different levels of decision conflict (M=17.81, SD=14.97) than controls (M=24.38, SD=25.35, t13=0.64, ns) or decision regret (M=21.88, SD=16.24, M=16.00, SD=19.12, respectively, t11=0.59, ns).

Conclusions: Patients felt the DAs provided helpful, balanced information that they would recommend to other patients. Furthermore, utilizing clinic staff is an efficacious way to get decision aids to patients. The impact of the DAs on the secondary outcomes will be tested in a future, adequately powered trial.

See more of: ORAL ABSTRACTS: ADVANCING EVALUATION METHODS AND FRAMEWORKS

See more of: 37th Annual Meeting of the Society for Medical Decision Making