Effectiveness of a web-based, individually tailored decision aid for depression or acute low back pain: A randomized controlled trial

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• 作者：Daniela Simon^a ; Levente Kriston^b ; ^{l.kriston@uke.de} ; Alessa von Wolff^b ; Angela Buchholz^b ; ^c ; Christine Vietor^d ; Torsten Hecke^d ; Andreas Loh^c ; Matthias Zenker^e ; Mario Weiss^e ; Martin Hä ; rter^a ; ^b ; ^{m.haerter@uke.uni-hamburg.de}
• 关键词：Patient decision aid ; Individual tailoring ; Depression ; Acute low back pain ; Randomized controlled trial ; Shared decision-making
• 刊名：Patient Education and Counseling
• 出版年：2012
• 期刊代码：217_07383991
• 类别：med
• 出版时间：June, 2012
• 卷：87
• 期：3
• 页码：360-368
• 文件大小：420 K

摘要

Objective

To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.

Methods

Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence.

Results

Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p = 0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p < 0.001).

Conclusion

PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account.

Practice implications

This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.