PATIENT RESPONSE TO A DECISION SUPPORT TOOL IN DEVELOPMENT: VETERANS LIKE ME

Purpose:

The purpose of this study is to examine patient response to a prototype decision support tool designed to allow Veteran patients to participate in shared decision making with their physicians for atrial fibrillation treatment to further development of the tool, Veterans Like Me.

Method:

A Veterans Like Me prototype was developed using principles of self-determination theory.  The prototype permits users to experience competence, relatedness, and a sense of autonomy.  The prototype represented risks of two comparison treatments for similar Veterans based on data from the VA electronic health record. Synthesized stories of Veterans are displayed on demand. A group of 25 patients participated in semi-structured interviews following a cardiology clinic visit for treatment of atrial fibrillation/flutter.  The interviews included questions regarding the patient’s history of atrial fibrillation/flutter, discussions with their physician about treatment options, and what they considered important when making treatment decisions. In addition, participants responded to aspects of the design of Veterans Like Me- responding to attributes, further needs, and likelihood of future use.  Transcripts of the interviews were systematically analyzed to identify themes related to reaction to the tool.  

Result:

Response to the tool was generally positive.  Most participants were interested in using the tool, and were impressed with the tool features.  Participants appreciated the ability to see both aggregated outcomes as well as individual’s stories, and  reported that the tool would assist them in their  understanding and decision-making. Patients reported that most decisions were based on invasiveness of the potential treatment, side effects, and perceived risk of mortality.  Particular side effects of great interest to participants included bleeding and stroke.  Participants identified additional factors they were interested in seeing in Veterans “like me” including attributes that might be clinically related to the disorder (e.g.  bodyweight, exercise history and alcohol use) as well as information for which there is no known association between the behavior and the disorder in question (e.g. agent orange exposure) and interactions between medications. Information needs about atrial fibrillation, common treatments, and treatment trajectories were high, suggesting redesign could focus on inclusion of basic information.

Conclusion:

The Veterans Like Me tool continues under development, potential changes include features to address information needs that emerged during this study.