Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care.
OBJECTIVE
To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes.


METHODS
Randomised controlled trial.


METHODS
26 general practices in the United Kingdom.


METHODS
205 women considering hormone replacement therapy.


METHODS
Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary.


METHODS
Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status.


RESULTS
Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used.


CONCLUSIONS
An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.
Murray
E
E
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA. elizabeth.murray@pcps.cul.ac.uk
Davis
H
H
Tai
S S
SS
Coulter
A
A
Gray
A
A
Haines
A
A
D003658:Decision Making, Computer-Assisted; D015914:Estrogen Replacement Therapy; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D019212:Multimedia; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000191:economics / Q000379:methods*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*