Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial.
OBJECTIVE
To describe how clinicians use decision aids.


BACKGROUND
A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters.


METHODS
Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos.


METHODS
Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation.


METHODS
Proportion and nature of unintended use of the Statin Choice decision aid.


RESULTS
We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters.


CONCLUSIONS
Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.
Abadie
Roberto
R
Health Sciences Doctoral Programs, Public Health, Graduate Center, City University of New York, NY, USA.
Weymiller
Audrey J
AJ
Tilburt
Jon
J
Shah
Nilay D
ND
Charles
Cathy
C
Gafni
Amiram
A
Montori
Victor M
VM
D002755:Choice Behavior; D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus; D006282:Health Personnel; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D014741:Video Recording
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors