Introduction
Methods
Study design
Decision aid development
Data source
AMI choice | Chest pain choice | Decision aids for diabetes (DAD) | Diabetes choice | Osteoporosis choice I/IIa
| |
---|---|---|---|---|---|
Trial registration
| NCT00888537 | NCT01077037 | NCT01029288 | NCT00388050 | NCT00578981, NCT00949611 |
Decision
| Intensive medical treatment to reduce 6-month mortality risk after acute myocardial infarction (AMI) | Disposition after ruling out acute coronary syndrome for patients presenting with chest pain | Use of statins to reduce 10-year cardiovascular risk (Statin choice) and choice of antihyper-glycemic medications (Diabetes choice) | Choice of antihyper-glycemic medications | Use of bisphosphonate to reduce 10-year fracture risk among post-menopausal women |
Setting
| Hospital | Emergency department | Primary care practices | Primary care practices | Primary care practices |
Data extracted
Fidelity (intended use of the decision aid)
Outcome measures
Socio demographic data
Statistical analyses
Results
AMI choice | Chest pain choice | Decision aids for diabetes (DAD) | Diabetes choice | Osteoporosis choice I/IIa
| All trials | |
---|---|---|---|---|---|---|
Patients enrolled to the SDM intervention arm, n | 53 | 101 | 53 | 48 | 84 | 339 |
Video recordings available, n (%)b
| 31 (58) | 98 (97) | 23 (43) | 28 (58) | 49 (58) | 229 (68) |
Patients
| ||||||
N (% of female) | 7 (23) | 56 (57) | 4 (17) | 14 (50) | 49 (100) | 131 (57) |
Age, mean (SD) | 65 (7) | 54 (12) | 60 (11) | 63(11) | 67 (9) | 60 (12) |
K-12 education, n (%)c
| 12 (41) | 27 (28) | 9 (39) | 10 (36) | 16 (34) | 74 (33) |
Income <40 k/year, n (%)d
| 14 (47) | 25 (28) | 6 (26) | 13 (50) | 16 (38) | 74 (35) |
Married, n (%)e
| 20 (65) | 45 (80) | 18 (78) | 12 (86) | 28 (72) | 123 (75) |
Commercial insurance, n (%)f
| 16 (52) | 75 (77) | 8 (89) | 12 (67) | 17 (35) | 128 (62) |
Clinicians
| ||||||
N (% female) | 3 (100) | 51 (25) | 16 (31) | 16 (44) | 36 (47) | 122 (37) |
Encounters per clinician, mean, median (range) | 10.3, 10 (5,16) | 1.9, 2 (1, 6) | 1.9, 1 (1, 8) | 2.6, 2 (1, 8) | 1.7, 1 (1,8) | 2.2, 1 (1, 16) |
Typeg
| ||||||
Staff physician, n (%) | ~ | 20 (41) | 12 (75) | 13 (81) | 25 (69) | 70 (58) |
Physician in training, n (%) | ~ | 26 (53) | 2 (12.5) | 0 (0) | 6 (17) | 34 (28) |
Nurse or nurse practitioner, n (%) | 3 (100) | 3 (6) | 2 (12.5) | 3 (19) | 5 (14) | 16 (14) |
Fidelity (intended use of the decision aid)
AMI choice | Chest pain choice | Decision aids for diabetes (DAD) | Diabetes medication choice | Osteoporosis choice | All | |
---|---|---|---|---|---|---|
Fidelity scorea
| 61.0 (57.5, 64.5) | 52.4 (47.1, 57.6) | 62.8 (51.1, 74.6) | 64.6 (56.3, 72.9) | 63.8 (58.2, 69.3) | 58.5 (55.5, 61.5) |
Information componenta
| 65.7 (57.3, 74.1) | 52.4 (47.1, 57.6) | 39.1 (23.8, 54.5) | 54.6 (44.1, 65.0) | 63.8 (58.2, 69.3) | 55.6 (52.1, 59.0) |
Decision making process componentsa
| 61.3 (56.7, 65.9) | 63.3 (58.9, 67.6) | 68.1 (58.4, 77.9) | 62.1 (53.4, 70.9) | 61.2 (54.6, 67.8) | 62.9 (60.2, 65.7) |
Eliciting values/preferencesb
| 0 (0) | 18 (18) | 12 (52) | 25 (89) | 7 (14) | 62 (27) |
Fidelity groupingb,c
| 10 (32) | 47 (48) | 12 (52) | 13 (46) | 27 (55) | 109 (47) |
Association of fidelity with trial outcomes
AMI choice | Chest pain choice | Decision aids for diabetes (DAD) | Diabetes medication choice | Osteoporosis choice | Allc
| |
---|---|---|---|---|---|---|
Patient involvement (OPTION score) | 0.563 | 0.006, R = 0.276 | 0.115 | 0.002, R = 0.556 | 0.641 | <0.0001, R2 = 0.542 |
DCS overall | 0.236 | 0.430 | 0.121 | 0.966 | 0.679 | 0.845, R2 = 0.023 |
DCS informed | 0.146 | 0.216 | 0.174 | 0.593 | 0.646 | 0.589, R2 = 0.034 |
DCS effective | 0.608 | 0.864 | 0.194 | 0.893 | 0.236 | 0.667, R2 = 0.031 |
DCS support | ~ | 0.399 | 0.457 | 0.674 | 0.576 | 0.261, R2 = 0.047 |
DCS values | ~ | 0.683 | ~ | 0.861 | 0.927 | 0.821, R2 = 0.013 |
DCS certainty | ~ | 0.946 | ~ | 0.968 | 0.470 | 0.690, R2 = 0.018 |
Knowledge | ~ | 0.065 | 0.194 | 0.053, R = 0.369 | 0.001, R = 0.455 | 0.011, R2 = 0.095 |
Knowledge of risk estimatesb
| 0.341 | 0.639 | ~ | ~ | 0.857 | 0.861 |
Satisfaction (willingness to recommend to others)b
| 0.481 | 0.269 | 0.470 | 0.649 | 0.952 | 0.251 |
AMI choice | Chest pain choice | DAD | Diabetes medication choice | Osteoporosis choice | Alla
| |
---|---|---|---|---|---|---|
Adherent to decision, n (%)
| 23 (88) | 66 (70) | 11 (85) | 20 (83) | 19 (63) | 139 (74) |
Mean difference of fidelity for Adherent vs. not, % (95% CI) | −2 (−15, 11) | 2 (−9, 14) | −6 (−46, 33) | 10 (−13, 33) | −13 (−29, 3) | 0.85 (0.2, 3.6) |
Fidelity with repeated use of decision aids
Compliant in all encounters | Not compliant in any encounters (n = 5) | Compliant in at least one but not all encounters (n = 12) | |
---|---|---|---|
(n = 8) | |||
n (%) | n (%) | n (%) | |
Clinician characteristics
| |||
Type: Staff physician | 5 (63) | 3 (60) | 7 (58) |
Physician in training | 3 (38) | 1 (20) | 3 (25) |
Nurse or nurse practitioner | 0 | 1 (20) | 2 (17) |
Female | 3 (38) | 1 (20) | 4 (33) |
Patient characteristics from encounters
| |||
Sex: Majority male | 4 (50) | 2 (40) | 5 (42) |
Majority female | 4 (50) | 3 (60) | 7 (58) |
Age, y: Majority <65 | 7 (87.5) | 2 (40) | 11 (92) |
Majority ≥65 | 1 (12.5) | 3 (60) | 1 (8) |
Education: majority collegeb
| 5 (25) | 3 (60) | 10 (83) |
Majority HS or less | 3 (25) | 2 (40) | 2 (17) |