title: Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.
abstract: BACKGROUND
  Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions.
  
  
  METHODS
  An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care.
  
  
  RESULTS
  This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01).
  
  
  CONCLUSIONS
  Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.
authors.affiliation: Dartmouth Centers for Health and Aging, Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway (HB7250), Lebanon, NH, 03766, USA. Aubri.S.Hoffman@Dartmouth.edu.
authors.forename: Aubri S
authors.initials: AS
authors.lastname: Hoffman
authors.affiliation: Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7250), Hanover, NH, 03755, USA. Hilary.A.Llewellyn-Thomas@dartmouth.edu.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.affiliation: Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7250), Hanover, NH, 03755, USA. Anna.N.A.Tosteson@Dartmouth.edu.|Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7505), Lebanon, NH, 03755, USA. Anna.N.A.Tosteson@Dartmouth.edu.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Department of Epidemiology, University of Ottawa, Ottawa, ON, K1H 8M5, Canada. AOConnor@uottawa.ca.
authors.forename: Annette M
authors.initials: AM
authors.lastname: O'Connor
authors.affiliation: Department of General Internal Medicine, Unit 1465, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77230, USA. BVolk@mdanderson.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Volk
authors.affiliation: Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03766, USA. Ivan.M.Tomek@Hitchcock.org.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Tomek
authors.affiliation: Collaboratory for Healthcare and Bioinformatics, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 330, Lebanon, NH, 03766, USA. Steven.B.Andrews@Dartmouth.edu.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Andrews
authors.affiliation: Dartmouth Centers for Health and Aging, Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway (HB7250), Lebanon, NH, 03766, USA. Stephen.J.Bartels@Dartmouth.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054626:Consumer Health Information / Q000379:methods*; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008490:Medical Informatics / Q000379:methods; D008875:Middle Aged; D009513:New Hampshire; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000628:therapy*; D057240:Patient Preference; D018802:Patient-Centered Care / Q000379:methods*; D014584:User-Computer Interface; D055815:Young Adult