The effect of a decision aid intervention on decision making about coronary heart disease risk reduction: secondary analyses of a randomized trial Public Deposited

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Creator
  • Keyserling, Thomas
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology, UNC Center for Health Promotion and Disease Prevention
  • Bangdiwala, Shrikant
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics, Cecil G. Sheps Center for Health Services Research, UNC Center for Health Promotion and Disease Prevention
  • Cai, Jianwen
    • Affiliation: Gillings School of Global Public Health, Department of Biostatistics, UNC Center for Health Promotion and Disease Prevention
  • Draeger, Lindy B
    • Affiliation: UNC Center for Health Promotion and Disease Prevention
  • Pignone, Michael
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology, Cecil G. Sheps Center for Health Services Research
  • Simpson, Ross, Jr.
    • Affiliation: School of Medicine, Division of Cardiology, Department of Medicine
  • Rimer, Barbara
    • Affiliation: Gillings School of Global Public Health
  • Sheridan, Stacey
    • Affiliation: Gillings School of Global Public Health, School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology, Cecil G. Sheps Center for Health Services Research, UNC Center for Health Promotion and Disease Prevention
  • Gizlice, Ziya
    • Affiliation: UNC Center for Health Promotion and Disease Prevention
Abstract
  • Abstract Background Decision aids offer promise as a practical solution to improve patient decision making about coronary heart disease (CHD) prevention medications and help patients choose medications to which they are likely to adhere. However, little data is available on decision aids designed to promote adherence. Methods In this paper, we report on secondary analyses of a randomized trial of a CHD adherence intervention (second generation decision aid plus tailored messages) versus usual care in an effort to understand how the decision aid facilitates adherence. We focus on data collected from the primary study visit, when intervention participants presented 45 minutes early to a previously scheduled provider visit; viewed the decision aid, indicating their intent for CHD risk reduction after each decision aid component (individualized risk assessment and education, values clarification, and coaching); and filled out a post-decision aid survey assessing their knowledge, perceived risk, decisional conflict, and intent for CHD risk reduction. Control participants did not present early and received usual care from their provider. Following the provider visit, participants in both groups completed post-visit surveys assessing the number and quality of CHD discussions with their provider, their intent for CHD risk reduction, and their feelings about the decision aid. Results We enrolled 160 patients into our study (81 intervention, 79 control). Within the decision aid group, the decision aid significantly increased knowledge of effective CHD prevention strategies (+21 percentage points; adjusted p<.0001) and the accuracy of perceived CHD risk (+33 percentage points; adjusted p<.0001), and significantly decreased decisional conflict (-0.63; adjusted p<.0001). Comparing between study groups, the decision aid also significantly increased CHD prevention discussions with providers (+31 percentage points; adjusted p<.0001) and improved perceptions of some features of patient-provider interactions. Further, it increased participants’ intentions for any effective CHD risk reducing strategies (+21 percentage points; 95% CI 5 to 37 percentage points), with a majority of the effect from the educational component of the decision aid. Ninety-nine percent of participants found the decision aid easy to understand and 93% felt it easy to use. Conclusions Decision aids can play an important role in improving decisions about CHD prevention and increasing patient-provider discussions and intent to reduce CHD risk.
Date of publication
Identifier
  • doi:10.1186/1472-6947-14-14
  • 24575882
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Stacey L Sheridan et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Medical Informatics and Decision Making
Journal volume
  • 14
Journal issue
  • 1
Page start
  • 14
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6947
Bibliographic citation
  • BMC Medical Informatics and Decision Making. 2014 Feb 28;14(1):14
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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