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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Stacey L Sheridan, Lindy B Draeger, Michael P Pignone, Barbara Rimer, Shrikant I Bangdiwala, Jianwen Cai, Ziya Gizlice, Thomas C Keyserling, Ross J Simpson Jr

Published in: BMC Medical Informatics and Decision Making | Issue 1/2014

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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.
Appendix
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Metadata
Title
The effect of a decision aid intervention on decision making about coronary heart disease risk reduction: secondary analyses of a randomized trial
Authors
Stacey L Sheridan
Lindy B Draeger
Michael P Pignone
Barbara Rimer
Shrikant I Bangdiwala
Jianwen Cai
Ziya Gizlice
Thomas C Keyserling
Ross J Simpson Jr
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2014
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/1472-6947-14-14

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