互动式决策辅助工具：一项旨在通过技术增强共享决策 RCT 的决策辅助工具的研究结果。

Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCT.

机构信息

Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.

Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.

出版信息

Am J Prev Med. 2019 Jul;57(1):77-86. doi: 10.1016/j.amepre.2019.03.004. Epub 2019 May 23.

DOI:10.1016/j.amepre.2019.03.004

PMID:31128959

Abstract

INTRODUCTION

Colorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with "usual care," but whether interactivity further increases CRCS rate remains unknown.

STUDY DESIGN

A two-armed RCT compared the effect of a web-based DA that interactively assessed patient CRC risk and clarified patient preference for specific CRCS test to a web-based DA with the same content but without the interactive tools.

SETTING/PARTICIPANTS: The study sites were 12 community- and three university-based primary care practices (56 physicians) in southeastern Michigan. Participants were men and women aged 50-75 years not current on CRCS.

INTERVENTION

Random allocation to interactive DA (interactive arm) or non-interactive DA (non-interactive arm).

MAIN OUTCOME MEASURES

Primary outcome was medical record documentation of CRCS 6 months after the intervention. Secondary outcome was patient decision quality (i.e., knowledge, preference clarification, and intent) measured immediately before and after DA use, and immediately after the office visit. To determine that either DA had a positive effect on CRCS adherence, usual care CRCS rates were determined from the three university-based practices among patients eligible for but not participating in the study.

RESULTS

Data were collected between 2012 and 2014; analysis began in 2015. At 6 months, CRCS rate was 36.1% (95% CI=30.5%, 42.2%) in the interactive arm (n=284) and 40.5% (95% CI=34.7%, 46.6%) in the non-interactive arm (n=286, p=0.29). Usual care CRCS rate (n=440) was 18.6% (95% CI=15.2%, 22.7%), significantly lower than both arms (p<0.001). Knowledge, attitude, self-efficacy, test preference, and intent increased significantly within each arm versus baseline, but the rate was not significantly different between the two arms.

CONCLUSIONS

The interactive DA did not improve the outcome compared to the non-interactive DA. This suggests that the resources needed to create and maintain the interactive components are not justifiable.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01514786.

摘要

简介

结直肠癌筛查（CRCS）的使用率仍然较低。与“常规护理”相比，决策辅助工具（DAs）可以增加患者的知识、意向和 CRCS 率，但互动是否能进一步提高 CRCS 率尚不清楚。

研究设计

一项两臂 RCT 比较了一种基于网络的 DA 的效果，该 DA 可互动评估患者的 CRC 风险，并明确患者对特定 CRCS 测试的偏好，与具有相同内容但无互动工具的基于网络的 DA 进行比较。

研究地点

密歇根州东南部的 12 个社区和 3 个大学基础医疗实践（56 名医生）。参与者为年龄在 50-75 岁之间、未进行过 CRCS 的男性和女性。

干预措施

随机分配到互动 DA（互动组）或非互动 DA（非互动组）。

主要观察指标

主要结果是干预后 6 个月医疗记录中 CRCS 的记录。次要结果是患者决策质量（即知识、偏好澄清和意向），在使用 DA 前后和就诊后立即进行测量。为了确定任何一种 DA 对 CRCS 依从性都有积极影响，从参与研究但未参与研究的 3 个大学实践中确定了常规护理 CRCS 率。

结果

数据收集于 2012 年至 2014 年之间；分析于 2015 年开始。在 6 个月时，互动组的 CRCS 率为 36.1%（95%CI=30.5%，42.2%）（n=284），非互动组为 40.5%（95%CI=34.7%，46.6%）（n=286，p=0.29）。常规护理 CRCS 率（n=440）为 18.6%（95%CI=15.2%，22.7%），明显低于两个组（p<0.001）。知识、态度、自我效能、测试偏好和意向在内的每个组与基线相比均显著增加，但两组之间的比率没有显著差异。