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Should Clinicians Deliver Decision Aids? Further Exploration of the Statin Choice Randomized Trial Results

Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN

Audrey J. Weymiller, CNP

Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN

Nilay Shah, PhD

Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, Division of Health Care Research and Policy, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN

Sandra C. Bryant, MS

Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN

Teresa J. H. Christianson, BS

Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN

Gordon H. Guyatt, MD, MSc

Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Amiram Gafni, PhD

Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Steven A. Smith, MD

Division of Endocrinology, Diabetes, Nutrition and Metabolism and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, Division of Health Care Research and Policy, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN

Victor M. Montori, MD, MSc

Knowledge and Encounter Research Unit, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, kerunit{at}mayo.edu

Background. Statin Choice is a decision aid about taking statins. The optimal mode of delivering Statin Choice (or any other decision aid) in clinical practice is unknown. Methods. To investigate the effect of mode of delivery on decision aid efficacy, the authors further explored the results of a concealed 2 x 2 factorial clustered randomized trial enrolling 21 endocrinologists and 98 diabetes patients and randomizing them to 1) receive either the decision aid or pamphlet about cholesterol, and 2) have these delivered either during the office visit (by the clinician) or before the visit (by a researcher). We estimated between-group differences and their 95% confidence intervals (CI) for acceptability of information delivery (1—7), knowledge about statins and coronary risk (0—9), and decisional conflict about statin use (0—100) assessed immediately after the visit. Follow-up was 99%. Results. The relative efficacy of the decision aid v. pamphlet interacted with the mode of delivery. Compared with the pamphlet, patients whose clinicians delivered the decision aid during the office visit showed significant improvements in knowledge (difference of 1.6 of 9 questions, CI 0.3, 2.8) and nonsignificant trends toward finding the decision aid more acceptable (odds ratio 3.1, CI 0.9, 11.2) and having less decisional conflict (difference of 7 of 100 points, CI -4, 18) than when a researcher delivered the decision aid just before the office visit. Conclusions. Delivery of decision aids by clinicians during the visit improves knowledge and shows a trend toward better acceptability and less decisional conflict.

Key Words: decision making • patient-provider communication • decision aids • patient participation.

This version was published on July 1, 2009

Medical Decision Making, Vol. 29, No. 4, 468-474 (2009)
DOI: 10.1177/0272989X09333120


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