Use of meta-analytic results to facilitate shared decision making

Objectives: Describe and evaluate an Internet-based approach to patient dec ision support using mathematical models that predict the probability of suc cessful treatment on the basis of meta-analytic summaries of the mean and s tandard deviation of symptom response. Design: An Internet-based decision support tool was developed to help patie nts with benign prostatic hypertrophy (BPH) determine whether they wanted t o use alpha blockers. The Internet site incorporates a meta-analytic model of the results of randomized trials of the alpha blocker terazosin. The sit e describes alternative treatments for BPH and potential adverse effects of alpha blockers. The site then measures patients' current symptoms and desi red level of symptom reduction. In response, the site computes and displays the probability of a patient's achieving his objective by means of terazos in or placebo treatment. Setting: Self-identified BPH patients accessing the site over the Internet. Main Outcome Measures: Patients' perceptions of the usefulness of informati on. Results: Over a three-month period, 191 patients who were over 50 years of age and who reported that they have BPH used the decision support tool. Res pondents had a mean American Urological Association (AUA) score of 18.8 and a desired drop in symptoms of 10.1 AUA points. Patients had a 40 percent c hance of achieving treatment goals with terazosin and a 20 percent chance w ith placebo. Patients found the information useful (93 percent), and most ( 71 percent) believed this type of information should be discussed before pr escribing medications. Conclusions: Interactive meta-analytic summary models of the effects of pha rmacologic treatments can help patients determine whether a treatment offer s sufficient benefits to offset its risks.