COMPARISON OF BRIEF VS LONG PATIENT DECISION AIDS ON DECISIONAL OUTCOMES IN RHEUMATOID ARTHRITIS
Method: Rheumatoid arthritis (RA) patients were presented, via mail survey, with a hypothetical decision scenario where they were asked to consider adding EnbrelTM (etanercept) to their current regimen. To prepare for the decision, each patient was randomized to review either an etanercept specific long, 24 page PtDA (LONG DA) or a short, 2 page PtDA (SHORT DA). Each subject was evaluated for: their decision to intensify therapy, strength of preference of decision, pre and post intervention knowledge, and decisional conflict (DCS).
Result: Equal number of patients were allocated to each intervention. The response rate was 52% with 266 participants. With formative evaluation of the PtDA, there was no difference in patient rating of: having information needed, being well organized, and being helpful in making a decision. 123 (14.6%) of patients who reviewed the LONG DA and 143 (14.0%) of who reviewed the SHORT DA chose to take etanercept (χ2=.023; NS). There was no significant difference between intervention groups in mean strength of preference to intensify therapy. Those who were randomized to the SHORT DA vs LONG DA had a greater increase in post-intervention etanercept related knowledge that 15.5% vs 10.5% (P< .02). There was no difference between interventions in: overall decisional conflict (DCS), nor informed, values clarity, uncertainty, or effective decision subscales. However, subjects who reviewed the SHORT DA had significantly higher score on the DCS support subscale (P< .04).
In this randomized clinical trial of decision support, a brief PtDA was not inferior to a traditional long format PtDA. Rather there is evidence of increased knowledge gain and feeling more supported to make a decision to intensify therapy. Brief PtDA are acceptable to patients and can effectively support patients preparing for complex medication decisions. Implementing simple decision supports at the point of care deserves further evaluation.