Informed choice assistance for women making uterine fibroid treatment decisions: a practical clinical trial.

BACKGROUND

There is limited evidence about how to ensure that patients are helped to make informed medical care decisions.

OBJECTIVE

To test a decision support intervention for uterine fibroid treatments.

DESIGN AND SETTING

Practical clinical trial to test informed choice assistance in 4 randomly assigned gynecology clinics compared to 5 others providing a pamphlet.

PATIENTS

Three hundred women facing a treatment decision for fibroids over a 13-month period.

INTERVENTION

Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit.

MEASUREMENTS

Mailed survey 6 to 8 weeks later asking about knowledge, preferences, and satisfaction with decision support.

RESULTS

In total, 244 surveys were completed for an adjusted response rate of 85.4%. On a 5-point scale, intervention subjects reported more treatment options being mentioned (3.0 v. 2.4), had a higher knowledge score (3.3 v. 2.8), and were more likely to report being adequately informed (4.4 v. 4.0), and their decision was both more satisfactory (4.3 v. 4.0) and more consistent with their personal values (4.5 v. 4.2). Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions.

LIMITATIONS

Implementation of intervention may not have been well timed to the decision for some patients, limiting their use of the materials and counseling.

CONCLUSION

It is difficult to integrate structured decision support consistently into practice. Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance.