title: Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.
abstract: BACKGROUND
  Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making.
  
  
  METHODS
  The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision-making. Two separate surveys were conducted: one in the control group and one in the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and were asked to choose between three hypothetical drug treatments, which varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief "washout" period, members of the control group made a second treatment choice after reviewing the balance sheet again, while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices, participants rated their degree of confidence in their choice on a 1 to 10 scale.
  
  
  RESULTS
  Members of the dashboard intervention group were more likely to change their choice of preferred drug (10.2 versus 7.5%; p = 0.054) and had a larger increase in decision confidence than the control group (0.67 versus 0.075; p < 0.03). There were no statistically significant between-group differences in decisional conflict or decision aid acceptability.
  
  
  CONCLUSIONS
  These findings suggest that clinical decision dashboards may be an effective point-of-care decision-support tool. Further research to explore this possibility is warranted.
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642, USA. james_dolan@urmc.rochester.edu.
authors.forename: James G
authors.initials: JG
authors.lastname: Dolan
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY, 14642, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Veazie
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D057240:Patient Preference; D018570:Risk Assessment