title: Use of Decision Support for Improved Knowledge, Values Clarification, and Informed Choice in Patients With Rheumatoid Arthritis.
abstract: OBJECTIVE
  To examine the potential value of a theory-based, interactive decision support tool in clinical practice for patients with rheumatoid arthritis who are candidates for biologic agents.
  
  
  METHODS
  We conducted an 8-week, 2-arm, parallel, single-blind pilot trial in which candidates for treatment escalation with a biologic agent were randomized to receive either a link to a web-based tool or usual care. Outcomes included changes in objective knowledge, subjective knowledge, values clarification, and satisfaction with risk communication as well as the proportion of subjects defined as making an informed choice to escalate care at 2 weeks.
  
  
  RESULTS
  A total of 125 subjects were randomized. Significant between-group differences at 2 weeks favoring the intervention group were seen for changes in objective knowledge, subjective knowledge, and values clarification. No significant between-group differences were found in subjects' satisfaction with risk communication. Among those deciding to escalate care, a greater percentage met the criteria for an informed choice at 2 weeks in the intervention group compared to the control group (32% versus 13%; P = 0.02). Improvements in subjective knowledge and values clarification persisted at 8 weeks. There were no between-group differences in objective knowledge at 8 weeks.
  
  
  CONCLUSIONS
  In this study, use of a decision support tool at the time of decision-making resulted in improved objective and subjective knowledge, as well as values clarity, compared to usual care. Not all improvements were sustained, emphasizing the need to offer educational support should additional escalation of care be required over the course of the illness.
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Matzko
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Debra E
authors.initials: DE
authors.lastname: Webb
authors.affiliation: Geisinger Medical Group, State College, Pennsylvania.
authors.forename: Brian
authors.initials: B
authors.lastname: Oppermann
authors.affiliation: Yale University, New Haven, Connecticut.
authors.forename: Peter
authors.initials: P
authors.lastname: Charpentier
authors.affiliation: Ohio State University, Columbus.
authors.forename: Ellen
authors.initials: E
authors.lastname: Peters
authors.affiliation: Cornell University, Ithaca, New York.
authors.forename: Valerie
authors.initials: V
authors.lastname: Reyna
authors.affiliation: Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Newman
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D010865:Pilot Projects; D016037:Single-Blind Method