Problem Statement

Effective patients' decision aids (PtDAs) help patients understand clinical information and reduce decisional conflict. PtDAs that also explicitly provide guidance through four “Deliberative Steps” may achieve additional gains in preparation for decision making.

Methods

Two versions were created of a web-based PtDA regarding the management of chronic knee osteoarthritis. The Information-Provision version provided clinical information (with optional “More Information” links to additional detail) and implicit deliberative guidance. The Information+Deliberation version provided the same clinical information and links, as well as explicit guidance through four Deliberative Steps: 1) Information Comprehension; 2) Values Clarification; 3) Consideration of Social Resources; and 4) Formation of an Action Plan. At each step, an optional interactive “Engagement Activity” was offered. In both versions, the program tracked selection of the information links; in the Information+Deliberation version, the program tracked engagement with the optional activities.

After pilot-testing, both versions were compared (N = 126) in terms of post-PtDA Preparation for Decision Making, Decision Self-efficacy, and Decisional Conflict. Sub-groups using the “More Information” links and the “Engagement Activities” were characterized.

Results

There were no statistically significant across-study-group differences in mean Preparation for Decision Making, Decision Self-efficacy, or Decisional Conflict scores.

Overall (N = 126), 46% of participants selected the “More Information” links. This sub-group was primarily female, Caucasian, college-degreed, reported higher decisional conflict, and had viewed the Information+Deliberation version.

In the Information+Deliberation study group (n = 64), 43% used the “Engagement Activities”. This sub-group was also female, Caucasian, college-educated, reported higher levels of pain and higher decisional conflict, as well as more familiarity with the decision. The percentages of engaging at each of the 4 Steps were 14%, 27%, 13%, and 22%, respectively.

Conclusions

In this clinical context, explicit guidance may not improve all patients' preparation for decision making, on average. Future studies should assess whether Type II error has occurred. Different “Deliberative Styles” may exist, and may benefit more/less from explicit guidance and optional detailed clinical information and interactive engagement.