A RANDOMIZED PILOT STUDY COMPARING THE EFFECTIVENESS OF TWO DECISION AIDS FOR STABLE CHEST DISCOMFORT

Purpose:

Decision aids (DAs) have been shown to increase decision quality in randomized controlled trials. However, there is a need for further understanding of how DAs with different modes of delivery may influence outcomes. Our aim was to compare the effectiveness of a linear DA video and booklet to an online interactive DA for treatment of stable angina.

Method:

Patients with angiogram-proven coronary artery disease (CAD) were sent an invitation to participate. Eligible participants were randomly assigned to either a long, linear DA or a short online, interactive DA from two different vendors. Participants completed a survey after viewing the material. The survey assessed patients’ knowledge, treatment preferences, use of and satisfaction with the educational materials, and open-ended reflections on the treatment decision making process. We compared the two DAs with respect to (1) amount of DA reviewed, (2) patient knowledge about percutaneous coronary intervention and medical management of CAD, and (3) patients’ opinion about the usefulness of the DA. We also solicited open-ended, qualitative feedback from participants.

Result:

Sixty two patients were screened, 34 patients agreed to participate and were randomly assigned to a group, and 15/17 linear and 13/17 online participants completed the survey. Patients were more likely to report reviewing all of the linear DA compared to the online DA (60% vs. 31%, p=0.15). Knowledge scores were significantly higher in the linear DA group than the online DA group (67% vs.47%, p=0.018). Participants in both arms felt it was very or extremely important that doctors give patients materials like these before a catheterization (93% for linear DA and 85% for online, p=0.54). Patients’ qualitative feedback highlighted significant gaps in knowledge about treatment options, as well as a strong desire to have educational materials in advance of diagnostic catheterizations. 

Conclusion:

The pilot study suggests that patients were more likely to review the longer, linear DA compared to the online DA. Further, the linear DA resulted in higher knowledge scores about CAD management. Larger studies are needed to confirm these findings and should examine the relative impact of the content versus mode of delivery on the utilization of decision aids and patient knowledge about CAD.