Elizabeth Drake

A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation

Although postmenopausal women are advised to consider their values when deliberating about potential benefits and risks of hormone therapy (HRT), feasible, effective methods of decision support in primary care have yet to be established. Using an explicit decision support framework, we developed a self-administered HRT decision aid and evaluated it in a before/after study of 94 women from six family practices. An audiotape guided women through an illustrated booklet including: detailed information about HRT benefits and risks tailored to a womans clinical risk, and a values clarification exercise to promote informed decision making consistent with personal values. After using the decision aid participants: had better general knowledge and more realistic personal expectations of HRT benefits and risks; and, felt more certain, informed, clear about values, and supported in decision making. Womens values elicited in the clarification exercise were 84% accurate in discriminating between decisions. Women with polarized preferences at baseline did not change their minds, but were better informed. Changes in preferences occurred in the uncertain group, with equal numbers accepting or declining HRT. Most participants found the decision aid comprehensible, acceptable in length and pace, and balanced. Decision aids are useful in preparing women for decision making about this complex, personal issue.

Randomized Trial of a Portable, Self-administered Decision Aid for Postmenopausal Women Considering Long-term Preventive Hormone Therapy

Although practice guidelines suggest that postmenopausal women learn about the benefits and nsks and consider their values when deciding about hormone therapy, the optimal decision-support method has not been established. In a randomized controlled trial, the authors compared the efficacy of a general educational pamphlet with that of a tailored decision aid. The pamphlet briefly summarized benefits, risks, and likely beneficiaries in general terms. The decision aid, delivered via booklet and audiotape, provided: detailed benefits and risks using functional terms and probabilities tailored to clinical risk; and steps for considering the issue in a womans own situation, including a value-clarification exercise. Compared with the pamphlet group, the decision-aid group had statistically significant (p < 0.05) improvements in terms of realistic personal expectations of the benefits and nsks, decisional conflict, and perceived acceptability of the intervention. Levels of general knowledge about the main benefits and nsks were comparable for the two interventions It is concluded that tailored decision aids prepare women for decision making better than do general pamphlets. Key words: decision making; choice behavior; informed consent; decision-support techniques; woman education; woman participation; health education; consumer satisfaction; hormone replacement therapy; menopause. (Med Decis Making 1998;18:295-303)

A survey of the decision-making needs of Canadians faced with complex health decisions.

Objective To describe the decision‐making needs of Canadians when faced with ‘complex’ health decisions characterized by balancing advantages against disadvantages. Although a national report emphasized that public confidence in the health‐care system depends on support for personal knowledge and decision‐making, there has been no systematic investigation of the Canadian populations decision‐making needs.

The effects of an `explicit' values clarification exercise in a woman's decision aid regarding postmenopausal hormone therapy

Objective To evaluate the incremental effect of a graphic weigh‐scale values clarification exercise to explicitly consider the personal importance of the benefits versus the risks in a womans decision aid regarding postmenopausal hormone therapy.

Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age

Objective:To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing.Setting:A regional genetics center.Design:A before/after study.Interventions:Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions.Subjects:21 women of advanced maternal age and 17 spouses.Main outcome measures:Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid.Results:After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid.Conclusions:The decision aid shows promise as a useful aid for preparing couples for counseling.

Development and preliminary testing of a patient decision aid to assist pharmaceutical care in the prevention of cardiovascular disease.

Study Objective. To develop and test a decision aid for patients with hypertension and/or dyslipidemia because a decision aid may assist in pharmaceutical care by providing relevant evidence‐based information.

Evaluation of a decision aid and a personal risk profile in community pharmacy for patients considering options to improve cardiovascular health: the OPTIONS pilot study

Objective In a pilot study, to assess the feasibility and relevance of providing a community pharmacist consultation supplemented by a decision aid (DA) or a personal risk profile (PRP) to patients on lipid‐lowering or antihypertensive pharmacotherapy. Preliminary data on the clinical effectiveness of these interventions were collected.

Can people find patient decision aids on the Internet

OBJECTIVE To determine if people could find patient decision aids (PtDAs) on the Internet using the most popular general search engines. METHODS We chose five medical conditions for which English language PtDAs were available from at least three different developers. The search engines used were: Google (www.google.com), Yahoo! (www.yahoo.com), and MSN (www.msn.com). For each condition and search engine we ran six searches using a combination of search terms. We coded all non-sponsored Web pages that were linked from the first page of the search results. RESULTS Most first page results linked to informational Web pages about the condition, only 16% linked to PtDAs. PtDAs were more readily found for the breast cancer surgery decision (our searches found seven of the nine developers). The searches using Yahoo and Google search engines were more likely to find PtDAs. The following combination of search terms: condition, treatment, decision (e.g. breast cancer surgery decision) was most successful across all search engines (29%). CONCLUSION While some terms and search engines were more successful, few resulted in direct links to PtDAs. PRACTICE IMPLICATIONS Finding PtDAs would be improved with use of standardized labelling, providing patients with specific Web site addresses or access to an independent PtDA clearinghouse.