Should clinicians deliver decision aids? Further exploration of the statin choice randomized trial results.
BACKGROUND
Statin Choice is a decision aid about taking statins. The optimal mode of delivering Statin Choice (or any other decision aid) in clinical practice is unknown.


METHODS
To investigate the effect of mode of delivery on decision aid efficacy, the authors further explored the results of a concealed 2 x 2 factorial clustered randomized trial enrolling 21 endocrinologists and 98 diabetes patients and randomizing them to 1) receive either the decision aid or pamphlet about cholesterol, and 2) have these delivered either during the office visit (by the clinician) or before the visit (by a researcher). We estimated between-group differences and their 95% confidence intervals (CI) for acceptability of information delivery (1-7), knowledge about statins and coronary risk (0-9), and decisional conflict about statin use (0-100) assessed immediately after the visit. Follow-up was 99%.


RESULTS
The relative efficacy of the decision aid v. pamphlet interacted with the mode of delivery. Compared with the pamphlet, patients whose clinicians delivered the decision aid during the office visit showed significant improvements in knowledge (difference of 1.6 of 9 questions, CI 0.3, 2.8) and nonsignificant trends toward finding the decision aid more acceptable (odds ratio 3.1, CI 0.9, 11.2) and having less decisional conflict (difference of 7 of 100 points, CI -4, 18) than when a researcher delivered the decision aid just before the office visit.


CONCLUSIONS
Delivery of decision aids by clinicians during the visit improves knowledge and shows a trend toward better acceptability and less decisional conflict.
Jones
Lesley A
LA
Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA.
Weymiller
Audrey J
AJ
Shah
Nilay
N
Bryant
Sandra C
SC
Christianson
Teresa J H
TJ
Guyatt
Gordon H
GH
Gafni
Amiram
A
Smith
Steven A
SA
Montori
Victor M
VM
D000368:Aged; D016000:Cluster Analysis; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000517:prevention & control* / Q000523:psychology; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data; D010361:Patients / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors