title: The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study.
abstract: BACKGROUND
  Shared decision-making can improve patient satisfaction and outcomes. To participate in shared decision-making, patients need information about the potential risks and benefits of treatment options. Our team has developed a novel prototype tool for shared decision-making called hearts like mine (HLM) that leverages EHR data to provide personalized information to patients regarding potential outcomes of different treatments. These potential outcomes are presented through an Icon array and/or simulated narratives for each "person" in the display. In this pilot project we sought to determine whether the inclusion of simulated narratives in the display affects individuals' decision-making. Thirty subjects participated in this block-randomized study in which they used a version of HLM with simulated narratives and a version without (or in the opposite order) to make a hypothetical therapeutic decision. After each decision, participants completed a questionnaire that measured decisional confidence. We used Chi square tests to compare decisions across conditions and Mann-Whitney U tests to examine the effects of narratives on decisional confidence. Finally, we calculated the mean of subjects' post-experiment rating of whether narratives were helpful in their decision-making.
  
  
  RESULTS
  In this study, there was no effect of simulated narratives on treatment decisions (decision 1: Chi squared = 0, p = 1.0; decision 2: Chi squared = 0.574, p = 0.44) or Decisional confidence (decision 1, w = 105.5, p = 0.78; decision 2, w = 86.5, p = 0.28). Post-experiment, participants reported that narratives helped them to make decisions (mean = 3.3/4).
  
  
  CONCLUSIONS
  We found that simulated narratives had no measurable effect on decisional confidence or decisions and most participants felt that the narratives were helpful to them in making therapeutic decisions. The use of simulated stories holds promise for promoting shared decision-making while minimizing their potential biasing effect.
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zeng-Treitler
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Gibson
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA. b.hill@utah.edu.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA. b.hill@utah.edu.
authors.forename: Brent
authors.identifier: http://orcid.org/0000-0002-0123-3565
authors.initials: B
authors.lastname: Hill
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Jorie
authors.initials: J
authors.lastname: Butler
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Christensen
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Redd
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Yijun
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.|Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bray
mesh_terms: D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D033262:Narration; D010358:Patient Participation / Q000523:psychology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Big data; Consumer health informatics; Patient decision aid; Personalized; Shared decision-making