title: A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal.
abstract: We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care.
  
  
  
  Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA).
  
  
  
  We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <-1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake.
  
  
  
  The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake.
  
  
  
  A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients' decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA. asmallwood@mcw.edu.
authors.forename: A J
authors.initials: AJ
authors.lastname: Smallwood
authors.affiliation: Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Ave, Philadelphia, PA, 19104, USA.|Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, 19104, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Clinical Informatics, Froedtert and the Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fedders
authors.affiliation: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.|Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, CLCC-5th Floor, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Neuner
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003657:Decision Making; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D010358:Patient Participation / Q000379:methods; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents
keywords: Decision aids; Osteoporosis; Patient portal; Personalized risk; Shared decision making