Monday, October 19, 2015: 5:45 PM
Grand Ballroom A (Hyatt Regency St. Louis at the Arch)

Holly O. Witteman, PhD1, Laura D. Scherer, PhD2, Nicole L. Exe, MPH3, Mark Dickson, MA3, Daniel Connochie, BA3 and Angela Fagerlin, PhD4, (1)Université Laval, Quebec City, QC, Canada, (2)University of Missouri, Columbia, MO, (3)University of Michigan, Ann Arbor, MI, (4)VA Ann Arbor Healthcare System & University of Michigan, Ann Arbor, MI
Purpose: Many people come to medical decision-making unused to participating in high-stakes health decisions. This study aimed to test whether providing people with a practice decision in a more familiar, less frightening context might help them with a subsequent medical decision.

Method: We first developed a novel values clarification method by applying best practices in interface design, including user-centered design methods. The values clarification method uses dynamic visual feedback throughout a decision aid to help people explore how well or poorly their available options align with their expressed values. We then randomized half of study participants in an online experiment to go through a practice travel decision followed by a medical decision. The other half of study participants were assigned only the medical decision. Participants randomized to the practice travel decision were asked to imagine that they had won a free trip and needed to choose one of four available travel options. For the medical decision, we asked participants to imagine they were diagnosed with early-stage breast cancer (women) or early-stage prostate cancer (men) and needed to choose a treatment. We carefully constructed the travel decision to closely mimic the medical decisions. We presented all decisions using the same decision aid interface design and values clarification method, showing participants how their values for different decision attributes (e.g., length of flight for the travel decision, length of hospital stay for the medical decision) aligned with their available options. After all participants completed the medical decision aid, we asked them (1) which medical treatment option they would choose, and (2) how confident they were that it was the best choice for them. 

Result: Participants (n=445) were a diverse sample of US adults (mean age 51, SD 8, 57% female, 82% white). Exposure to the practice travel decision was not associated with any differences in participants’ medical treatment choices (men: Chi-squared(3)=3.15, p=0.37; women: Chi-squared(2)=1.35, p=0.51), but it was associated with increased confidence in their medical decisions (F(1,443)=5.62, p=.02).

Conclusion: Giving people a practice decision in a less threatening context may help them feel more confident in their abilities to make medical decisions that reflect what matters to them.