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Can Computerized Decision Support Help Patients Make Complex Treatment Decisions? A Randomized Controlled Trial of an Individualized Menopause Decision Aid

Brown Medical School, Providence, Rhode Island, USA, coln{at}mmc.org

Long Ngo, PhD

Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA

Jennifer M. Fortin, MPH

Brigham and Women's Hospital, Boston, Massachusetts, USA

Robert J. Goldberg, PhD

University of Massachusetts, Worcester, Massachusetts, USA

Annette M. O'Connor, PhD, RN

University of Ottawa, Ottawa Health Research Institute, Ottawa, Ontario, Canada

Purpose. To compare the effectiveness of an individualized decision aid (DA) with standard educational materials on decisions about menopausal treatments and to assess the feasibility of integrating this DA into clinical practice, with and without coaching. Methods. We conducted a 3-armed randomized controlled trial in 3 clinics, enrolling menopausal women between the ages of 45 and 65 years with primary care appointments. Of the 145 women included, 99 completed a 2-week follow-up. The control group received generic educational materials, 1 intervention group received an individualized computer-generated DA mailed to patients and their clinicians before clinic appointment, and the 2nd intervention group received the same DA along with coached care before clinic appointment (DA + CC). Decisional conflict, satisfaction, and knowledge were measured 2 weeks after clinic appointment. Results. Participants' mean age was 52 years, and 97% were white. Most women (98%) read all or most of the documents. Decisional conflict was significantly lower in both intervention groups but not in the control group. DA reduced decisional conflict from preintervention to postintervention (pre—post change) by 0.70 (SD = 0.56) points (on a 1—5 scale), compared to reductions of 0.51 (SD = 0.51) and 0.09 (SD = 0.44) for the DA + CC group and the control group, respectively. Satisfaction with the decision made was significantly higher at 2 weeks in the DA v. control group. Self-reported knowledge significantly improved in DA + CC compared to controls. Conclusion. Our decision aid lowered decisional conflict and improved patient satisfaction; adding coaching provided little additional benefit.

Key Words: Key words: decision aid • menopause • randomized clinical trial • coached care • clinical applications • decision analysis. (Med Decis Making 2007;27:585—598)

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This version was published on October 1, 2007

Medical Decision Making, Vol. 27, No. 5, 585-598 (2007)
DOI: 10.1177/0272989X07306781


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