Salkeld Glenn, Cunich Michelle, Dowie Jack, Howard Kirsten, Patel Manish I, Mann Graham, Lipworth Wendy
Faculty of Social Sciences, University Of Wollongong, Wollongong, NSW, Australia.
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
PLoS One. 2016 Apr 6;11(4):e0152999. doi: 10.1371/journal.pone.0152999. eCollection 2016.
Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether "personalising" choice within decisions aids leads to better decision quality.
To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test.
Randomized controlled trial.
Australia.
1,970 men aged 40-69 years were approached to participate in the trial.
1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes.
To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes.
5% of men in the fixed attribute group scored 'Have a PSA test' as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months.
Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886.
决策支持工具可帮助人们将基于人群的利弊证据应用于个人健康决策。一个关键问题是，在决策辅助工具中进行“个性化”选择是否能带来更高的决策质量。
评估使用前列腺特异性抗原（PSA）检测对前列腺癌筛查决策辅助工具内容进行个性化设置的效果。
随机对照试验。
澳大利亚。
邀请了1970名年龄在40 - 69岁的男性参与试验。
1447名男性被随机分配到两种决策辅助工具组，一组是具有固定的五个属性集的标准决策辅助工具，另一组是可从多达10个属性中选择纳入内容的个性化决策辅助工具。
确定两组在以下方面是否存在差异：1）决策辅助工具产生的进行PSA检测或不进行检测的初步意见；2）完成在线决策辅助工具后的自我评估决策质量；3）他们在未来12个月内进行筛查的意向。我们还想确定个性化选择组的男性是否使用了额外的决策属性。
固定属性组中有5%的男性将决策辅助工具产生的意见评为“进行PSA检测”，而个性化选择组中这一比例为62%（χ² = 569.38，自由度为2，p < 0.0001）。使用个性化决策辅助工具的男性决策质量略高（t = 2.157，自由度 = 1444，p = 0.031）。个性化选择组的男性广泛使用了额外的决策属性。两组在未来12个月内进行筛查的意向方面没有差异。
总体而言，这些发现表明个性化决策支持系统可能是共同决策和以患者为中心的医疗中的一项重要进展。
澳大利亚新西兰临床试验注册中心（ANZCTR）ACTRN12612000723886 。
