This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Protheroe, J. Articles by Fahey, T. Search for Related Content PubMed PubMed Citation Articles by Protheroe, J. Articles by Fahey, T. Pubmed/NCBI databases Medline Plus Health Information Vaginal Bleeding Social Bookmarking                         What's this?

Effectiveness of a Computerized Decision Aid in Primary Care on Decision Making and Quality of Life in Menorrhagia: Results of the MENTIP Randomized Controlled Trial

National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom, j.protheroe{at}manchester.ac.uk

Peter Bower, PhD

National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom

Carolyn Chew-Graham, MD

Rusholme Academic Unit, School of Community Based Medicine, University of Manchester, Manchester, United Kingdom

Tim J. Peters, PhD

Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom

Tom Fahey, MD

Division of Community Health Services, University of Dundee, Mackenzie Building, Dundee, United Kingdom

Background. Computerized decision aids have the potential to increase patient involvement in the decision-making process. However, most published evidence concerning the effectiveness of decision aids is from secondary care. Aim. To evaluate whether the addition of a computerized decision aid to written information improves decision making in women consulting their general practitioner with menorrhagia comparedwithwritten informationalone. Design of study. Randomized controlled trial. Setting. Nineteen general practices in the North of England. Method. One hundred forty-nine women presenting with menorrhagia were randomized to receive written information and access to a computerized decision aid or written information alone. Outcomes were assessed using postal questionnaires. These were scores on the Decisional Conflict Scale and State-Trait Anxiety Inventory anxiety scale at 2 weeks and the Menorrhagia Specific Utility quality-of-life scale, knowledge about menorrhagia, and anxiety and process measures at 6 months. Results. Two weeks after the intervention, there was significantly less decisional conflict in the intervention group (adjusted difference = –16.6; 95% confidence interval [CI] = –21.5 to –11.7; P < 0.001). At 6 months, the intervention group showed better knowledge about menorrhagia (adjusted difference = 9.3 ; 95% CI = 1.9 to 16.6; P = 0.014) and menorrhagia quality of life (adjusted difference = 10.9; 95% CI = 0.9 to 21.0; P = 0.033). There was no difference in anxiety scores at either 2 weeks or 6 months. Conclusions. A computerized decision aid, used outside of the primary care consultation, is effective in increasing patient involvement in decision making in primary care.

Key Words: Key words: decision aids • shared decision making • patient participation • menorrhagia. (Med Decis Making 2007;27:575—584)

References

• Department of Health, NHS Executive. Patient Partnership: Building a Collaborative Strategy. Leeds (UK): Department of Health, NHS Executive; 1996.
• Department of Health. Choosing Health: Making Healthy Choices Easier. London: Department of Health; 2004.
• Montgomery AA, Fahey T., Peters TJ A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract. 2003;53(491):446—53.[Web of Science][Medline] [Order article via Infotrieve]
• Bekker HL, Hewison J., Thornton JG Applying decision analysis to facilitate informed decision making about prenatal diagnosis for Down syndrome: a randomised controlled trial. Prenat Diagn. 2004;24(4):265—75.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dowding D., Bland R., Swanson V., et al. Randomised Trial of the Effect of a Computerised Decision Aid on Patient Adherence to Treatment. Unpublished manuscript; 2005.
• O'Connor AM, Stacey D., Entwistle V., et al. Decision Aids for People Facing Health Treatment or Screening Decisions, a Cochrane Review. The Cochrane Library, Issue 2. Oxford (UK): Update Software; 2003.
• Protheroe J. Management of menorrhagia in primary care. Women's Health Update. 2001;2:1—3.[Medline] [Order article via Infotrieve]
• Royal College of Obstetricians and Gynaecologists. The Initial Management of Menorrhagia. London: Royal College of Obstetricians and Gynaecologists; 1998.
• Prentice A. Medical management of menorrhagia. BMJ. 1999; 319:1343—1345.[Free Full Text]
• Lethaby A., Farquhar C. Treatments for heavy menstrual bleeding. BMJ. 2003;327(7426):1243—4.[Free Full Text]
• Protheroe J., Chew-Graham CA The role of primary care in the diagnosis and management of menorrhagia: a qualitative study of women with menorrhagia. Primary Health Care Research and Development. 2005;6:217—23.[CrossRef]
• Campbell M., Fitzpatrick R., Haines A., et al. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321(7262):694—6.[Free Full Text]
• Jarman B. Identification of underprivileged areas. Br Med J (Clin Res Ed). 1983;286(6379):1705—9.[Medline] [Order article via Infotrieve]
• Treasure T., MacRae KD. Minimisation: the platinum standard for trials?. Randomisation doesn't guarantee similarity of groups; minimisation does. BMJ. 1998;317(7155):362—3.[Free Full Text]
• Dowding D., Swanson V., Bland R., et al. The development and preliminary evaluation of a decision aid based on decision analysis for two treatment conditions: benign prostatic hyperplasia and hypertension. Patient Educ Couns. 2004;52(2):209—15.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Protheroe J. Modern management of menorrhagia. J Fam Plann Reprod Health Care. 2004;30(2):118—22.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• O'Connor AM Validation of a decisional conflict scale. Med Decis Making. 1995;15:25—30.[Medline] [Order article via Infotrieve]
• Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992;31(Pt 3):301—6.[Web of Science][Medline] [Order article via Infotrieve]
• Shaw RW, Brickley M., Evans L., Edwards M. Perceptions of women of the impact of menorrhoea on their health using multi-attribute utility assessment. Br J Obstet Gynaecol. 1998;105: 1155—9.[Web of Science][Medline] [Order article via Infotrieve]
• O'Connor AM, Tugwell P., Wells GA, et al. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33: 267—79.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• O'Connor A., Tugwell P., Wells GA, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventative hormone therapy. Med Decis Making. 1998;18:295—303.[Abstract/Free Full Text]
• Hollis S., Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999;319(7211):670—4.[Abstract/Free Full Text]
• Green MJ, Biesecker BB, McInerney AM, Mauger D., Fost N. An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility. Am J Med Genet. 2001;103(1):16—23.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Dolan JG, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22(2):125—39.[Abstract/Free Full Text]
• Rostom A., O'Connor A., Tugwell P., Wells G. A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-menopausal hormone replacement therapy. Patient Educ Couns. 2002;46(1):67—74.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Vuorma S., Teperi J., Aalto AM, Hurskainen R., Kujansuu E., Rissanen P. A randomized trial among women with heavy menstruation—impact of a decision aid on treatment outcomes and costs. Health Expect. 2004;7(4):327—37.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kennedy Adm, Sculpher MJ, Coulter A., et al. Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs. JAMA. 2002;288:2701—8.[Abstract/Free Full Text]
• British Medical Association. New GMS Contract: Investing in General Practice. London: British Medical Association; 2003.

This version was published on October 1, 2007

Medical Decision Making, Vol. 27, No. 5, 575-584 (2007)
DOI: 10.1177/0272989X07306785


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. Protheroe, P. Bower, and C. Chew-Graham The use of mixed methodology in evaluating complex interventions: identifying patient factors that moderate the effects of a decision aid Fam. Pract., December 1, 2007; 24(6): 594 - 600. [Abstract] [Full Text] [PDF]

				M. Pignone Incorporating Decision Analysis in Decision Aids Med Decis Making, October 1, 2007; 27(5): 547 - 549. [PDF]

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Protheroe, J. Articles by Fahey, T. Search for Related Content PubMed PubMed Citation Articles by Protheroe, J. Articles by Fahey, T. Pubmed/NCBI databases Medline Plus Health Information Vaginal Bleeding Social Bookmarking                         What's this?