Pilot test of a patient decision aid about liver transplant organ quality.
Prior studies have shown that patients are reluctant to accept donor-specific risks, and transplant professionals lack an effective and time-efficient means of obtaining informed consent. We designed and pilot-tested a Web-based patient decision aid (DA) on organ quality. The DA was administered to 53 liver transplant candidates (median Model for End-Stage Liver Disease score = 14, range = 7-26), and they took a mean of 15 minutes to complete it. Questions about knowledge and attitudes were asked before and after the DA. Subjects' knowledge improved, with 53% and 60% correctly answering questions about hepatitis B virus and human immunodeficiency virus transmission before the DA and 94% and 100%, respectively, correctly answering them afterward (P < 0.001). The accuracy of mortality prediction also improved from a mean 3-month mortality estimate of 22% before the DA to 12% afterward (P < 0.001). After the DA, subjects felt that it was more likely that they might be offered a less-than-perfect liver (P = 0.001), and they were more likely to consider accepting such a liver (P < 0.001). In conclusion, implementing a Web-based patient DA is feasible and improves knowledge among liver transplant candidates. The use of this tool may decrease candidates' reluctance to accept extended criteria organs.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, MI.
Michael L
ML
Volk
Meghan
M
Roney
Angela
A
Fagerlin
D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006509:Hepatitis B / Q000517:prevention & control; D006801:Humans; D020407:Internet; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010865:Pilot Projects; D016896:Treatment Outcome; D014584:User-Computer Interface; D055815:Young Adult