title: Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.
abstract: OBJECTIVE
  Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.
  
  
  METHODS
  Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.
  
  
  RESULTS
  We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01), improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively), had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001). Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer). There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07); medication adherence at 6 months was no different across arms.
  
  
  CONCLUSIONS
  Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.
  
  
  BACKGROUND
  clinical trials.gov NCT00949611.
authors.affiliation: Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States of America; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America; Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
authors.affiliation: Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States of America.
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America; Department of Medicine, Division of Pediatrics, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Kirk
authors.initials: K
authors.lastname: Wyatt
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.affiliation: Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States of America; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Holly
authors.initials: H
authors.lastname: Van Houten
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Laurie
authors.initials: L
authors.lastname: Pencille
authors.affiliation: Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Wermers
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States of America; Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, MN, United States of America.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000368:Aged; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods*
chemical_list: D004164:Diphosphonates