Patient Decision Support intervention - Increased consistency with decision analytic models

BACKGROUND. Patient Decision Support (PDS) tools assist patients in using m edical evidence to make choices consistent that are with their values and i n using evidence about consequences of medical alternatives. Objective. TO evaluate a PDS intervention for perimenopausal hormone replac ement therapy. We assessed the impact of the PDS on (1) consistency between the decision to take estrogen replacement therapy (ERT) or progesterone/es trogen replacement therapy (PERT) and the expected utility of treatment and (2) likelihood to take ERT and PERT pre- and postintervention. DESIGN. Content of the PDS was standardized. Randomized trial of three inte nsities of intervention: (1) brochure; (2) lecture/discussion; and (3) acti ve decision support. SUBJECTS. Participants were perimenopausal community volunteers between the ages of 40 and 65 (n = 248). MEASURES. (1) Consistent with values (correlation between expected utility (EU) and likelihood of taking hormones); and (2) Likelihood to take hormone replacement therapy. RESULTS. (1) The brochure group was less consistent with the decision analy tic model than the lecture/discussion and active decision support groups. ( 2) Influence on decisions: PDS tools increased the number of women certain about whether or not to take hormones. There were no differences among expe rimental groups. Of 99 women uncertain about ERT pre-PDS, 65% changed. Twen ty-one (32%) decided against ERT and 44 (68%) decided for ERT. (3) More int ensive interventions produced modest gains in a normative direction. Conclusions. PDSs using any of 3 formats reduce uncertainty and assist wome n to make informed decisions. Increased consistency with decision analytic models appears to be driven by better estimates of likelihood of outcomes.