Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care

Objective To determine whether a decision aid on benign prostatic hypertrop hy influences decision making, health outcomes, and resource use. Design Randomised controlled trial. Setting 33 general practices in the United Kingdom. Participants 112 men with benign prostatic hypertrophy. Intervention 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, conflict over decisions, treatment choice and prostatectom y rate, American Urological Association symptom scale, costs, anxiety, util ity, and general health status. Results Both patients and general practitioners found the decision aid acce ptable. A higher proportion of patients (32% v 4%; mean difference 28%,95% confidence interval 14% to 40%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group . Patients in the intervention group had significantly lower decisional con flict scores than those in the control group at 3 and 9 months (2.3 v 2.6; - 0.3, - 0.5 to - 0.1, P < 0.01 at 3 months). No differences were found bet ween the groups for anxiety general health status, prostatic symptoms, util ity, or costs (excluding costs associated with the video disc equipment). Conclusions The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decis ion making. Such programmes could be delivered cheaply over the internet, a nd there are good arguments for coordinated investment in them, particularl y for conditions in which patient utilities are important.