Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care

Objective To determine whether a decision aid on hormone replacement therap y influences decision making and health outcomes. Design Randomised controlled trial. Setting 26 general practices in the United Kingdom. Participants 205 women considering hormone replacement therapy. Interventio n Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. Outcome measures Patients' and general practitioners' perceptions of who ma de the decision, decisional conflict, treatment choice, menopausal symptoms , costs, anxiety, and general health status. Results Both patients and general practitioners found the decision aid acce ptable. At three months, mean scores for decisional conflict were significa ntly lower in the intervention group than in the control group (2.5 v 2.8; mean difference - 0.3, 95% confidence interval - 0.5 to - 0.2); this differ ence was maintained during follow up. A higher proportion of general practi tioners perceived that treatment decisions had been made "mainly or only" b y the patient in the intervention group than mi the control group (55% v 31 %; 24%, 8% to 40%). At three months a lower proportion of women in the inte rvention group than in the control group were undecided about treatment (14 % v 26%; - 12%, - 23% to - 0.4%), and a higher proportion had decided again st hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differenc es were no longer apparent by nine months. No differences were found betwee n the groups for anxiety, use of health service resources, general health s tatus, or utility. The higher costs of the intervention were largely due to the video disc technology used. Conclusions An interactive multimedia decision aid in the NHS would be popu lar with patients, reduce decisional conflict, and enable patients to play a more active part in decision making without increasing anxiety. The use o f web based technology would reduce the cost of the intervention.