Assignment: Value-based Decisions

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Assignment: Value-based Decisions

Assignment: Value-based Decisions

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Studies to date have demonstrated

that while decision aids enhance knowledge,

reduce decisional conflict, increase involvement

in the decision-making process and lead to

informed value-based decisions, their impact on

the quality of the decision, satisfaction with the

decision making process and health outcomes

remains unclear.11

Besides enabling patients to make informed

choices, decision aids also have the potential to

facilitate SDM by improving the quality and

efficiency of the patient–provider encounter.

Relatively few studies have examined the utility

of decision aids for promoting effective SDM

from the perspective of the provider. Studies to

date have largely focused on provider perspec-

tives on the quality of the decision tools

themselves or issues related to implementation

into clinical practice.11–15 The overall objective

of this study was to elicit provider feedback

regarding the extent to which the use of a novel

colorectal cancer (CRC) screening decision aid

facilitated SDM in the primary care setting

within the context of a randomized clinical

trial.

Methods

Brief overview of decision aid and randomized

clinical trial

Details of the decision aid, recruitment process,

study design and secondary outcome results

have been previously published.16 The overall

objective of the trial was to evaluate the impact

of a novel computer-based decision aid on SDM

and patient adherence to CRC screening rec-

ommendations. The decision aid uses video-

taped narratives and state-of-the-art graphics in

digital video disc (DVD) format to convey key

information about CRC and the importance of

screening, compare each of five recommended

screening options using both attribute- and

option-based approaches, and elicit patient

preferences. A modified version of the tool also

incorporated the web-based �Your Disease Risk (YDR)� CRC risk assessment tool (http:// www.yourdiseaserisk.wustl.edu). To assess its

impact on SDM and screening adherence,

average-risk, English-speaking patients 50–

75 years of age due for CRC screening were

randomized to one of the two intervention arms

(decision aid plus the YDR personalized risk

assessment tool with feedback or decision aid

alone) or a control arm, each of which involved

an interactive computer session just prior to a

scheduled visit with their primary care provider

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