Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer?
OBJECTIVE
It is thought that patients fare better when they participate in treatment decision-making, and when they have more control over the amount and type of information they receive. To facilitate informed decision-making, interactive decision aids have been introduced in health care. This article describes how much, and which information patients select from an interactive decision aid on breast cancer. To explore whether the interactive system facilitates that different patients receive different information, associations between patients' characteristics and information selection are inspected.


METHODS
The interactive decision aid was provided to 106 patients after an initial discussion with their surgeon about their diagnosis and treatment options. Information regarding patients' age, completed education, treatment preference, psychological functioning, decision uncertainty and decision style was collected with a written, structured questionnaire. The questionnaire was completed before patients used the interactive decision aid. To create categories, a median-split procedure was employed on the scores of the continuous background variables. The information patients selected from the interactive decision aid were registered into logfiles. Associations between patients' background variables and information selection were investigated by means of univariate statistics.


RESULTS
Patients (n=97; 92%) used the interactive decision aid intensively. On average, patients spent almost 70min searching for information and selected 21 information topics. Overall, treatment related information was clearly more selected than other types of information. Age, education, and decision style factors were associated with information selection.


CONCLUSIONS
The interactive breast cancer decision aid was utilized intensively. The interactive system was found to facilitate that different patients received different amounts and types of information.


CONCLUSIONS
Interactive decision aids may improve information giving to patients, and as a result, the quality of care. To safeguard informed-choice, decision aids should be used in conjunction with other communication strategies. Decision aids should be available continuously and throughout the patients' disease journey. The Internet may help to achieve broad dissemination and enduring access.
Molenaar
Sjaak
S
Academic Medical Center, University of Amsterdam, Department of Medical Psychology (Room J3-401), P.O. Box 22 660, 1100 DD Amsterdam, The Netherlands. J.Molenaar@AMC.UvA.NL
Sprangers
Mirjam
M
Oort
Frans
F
Rutgers
Emiel
E
Luiten
Ernest
E
Mulder
Jan
J
van Meeteren
Marjolijn
M
de Haes
Hanneke
H
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001362:Avoidance Learning; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D016251:CD-ROM / Q000592:standards; D002755:Choice Behavior; D003142:Communication; D003194:Computer-Assisted Instruction / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007258:Informed Consent; D007389:Internal-External Control; D008408:Mastectomy / Q000193:education / Q000523:psychology; D015412:Mastectomy, Segmental / Q000193:education / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011795:Surveys and Questionnaires; D035501:Uncertainty; D014584:User-Computer Interface