title: An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives.
abstract: BACKGROUND
  The last 15 years have witnessed considerable progress in the development of decision support interventions (DESIs). However, fundamental questions about design and format of delivery remain.
  
  
  METHODS
  An exploratory, randomized mixed-method crossover study was conducted to compare a DVD- and Web-based DESI. Randomized participants used either the Web or the DVD first, followed by the alternative format. Participants completed a questionnaire to assess decision-specific knowledge at baseline and a questionnaire and structured qualitative interview after viewing each format. Tracking software was used to capture Web utilization. Transcripts were analyzed using integrated inductive and deductive approaches. Quantitative data were analyzed using exploratory bivariate and multivariate analyses.
  
  
  RESULTS
  Exploratory knowledge analyses suggest that both formats increased knowledge, with limited evidence that the DVD increased knowledge more than the Web. Format preference varied across participants: 44% preferred the Web, 32% preferred the DVD and 24% preferred 'both'. Patient discussions of preferences for DESI information structure and the importance of a patients' stage of a given decision suggest these characteristics may be important factors underlying variation in utilization, format preferences and knowledge outcomes.
  
  
  CONCLUSIONS
  Our results suggest that both DESI formats effectively increase knowledge. Patients' perceptions of these two formats further suggest that there may be no single 'best' format for all patients. These results have important implications for understanding why different DESI formats might be preferable to and more effective for different patients. Further research is needed to explore the relationship between these factors and DESI utilization outcomes across diverse patient populations.
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
authors.forename: Meghan C
authors.initials: MC
authors.lastname: Halley
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.|University of Michigan, Ann Arbor, MI, USA.
authors.forename: Katharine A S
authors.initials: KA
authors.lastname: Rendle
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Gillespie
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Stanley
authors.affiliation: Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.|Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA, USA.|University of California, Los Angeles, CA, USA.
authors.forename: Dominick L
authors.initials: DL
authors.lastname: Frosch
mesh_terms: D000368:Aged; D001294:Attitude to Health; D015179:Colorectal Neoplasms / Q000175:diagnosis; D018592:Cross-Over Studies; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000628:therapy; D055088:Early Detection of Cancer; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011470:Prostatic Hyperplasia / Q000628:therapy; D011795:Surveys and Questionnaires; D014741:Video Recording
keywords: decision aids; patient engagement; patient preferences; qualitative research