title: A tale of two studies: the importance of setting, subjects and context in two randomized, controlled trials of a web-based decision support for perimenopausal and postmenopausal health decisions.
abstract: OBJECTIVE
  Knowledge relevant to women's peri- and postmenopausal health decisions has been evolving rapidly. Web-based decision supports can be rapidly updated and have the potential to improve the quality of patients' decisions. We developed and tested a web-based decision support for peri- and postmenopausal health decisionmaking.
  
  
  METHODS
  We recruited 409 women aged 45-75 for one randomized, controlled trial and 54 women with an upcoming clinic appointment for a subsequent trial. Women were randomized to use the web-based decision support versus a printed brochure (first trial) and usual care (second trial). Outcomes were changes in decisional satisfaction, decisional conflict, and knowledge, both within each trial and compared across the trials.
  
  
  RESULTS
  Intervention subjects had greater increases in decisional satisfaction in the second trial and knowledge in both trials. A high dropout rate among women randomized to the website in the first trial effectively negated benefits in that trial, but not in the second.
  
  
  CONCLUSIONS
  The utility of this web-based decision support in two trials depended on a number of factors that appear related to the urgency of making a decision.
  
  
  CONCLUSIONS
  Decision aids should be targeted to patients actively trying to make a decision.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Benedict Building, Worcester, MA 01655, USA. Barry.Saver@umassmed.edu
authors.forename: Barry G
authors.initials: BG
authors.lastname: Saver
authors.forename: David
authors.initials: D
authors.lastname: Gustafson
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Taylor
authors.forename: Robert P
authors.initials: RP
authors.lastname: Hawkins
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Woods
authors.forename: Susan
authors.initials: S
authors.lastname: Dinauer
authors.forename: Susan
authors.initials: S
authors.lastname: Casey
authors.forename: Aileen
authors.initials: A
authors.lastname: MacLaren-Loranger
mesh_terms: D000368:Aged; D003194:Computer-Assisted Instruction / Q000379:methods / Q000592:standards; D003220:Conflict, Psychological; D003661:Decision Support Techniques; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet / Q000592:standards*; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D017060:Patient Satisfaction; D047648:Perimenopause / Q000187:drug effects / Q000523:psychology*; D017698:Postmenopause / Q000187:drug effects / Q000523:psychology*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards; D035501:Uncertainty; D014481:United States; D014930:Women / Q000193:education / Q000523:psychology