Veterans Like Me: Formative evaluation of a patient decision aid design.

Patient decision aids are tools intended to facilitate shared decision-making. Currently development of a patient decision aid is resource intensive: it requires a decision-specific review of the scientific literature by experts to ascertain the potential outcomes under different treatments. The goal of this project was to conduct a formative evaluation of a generalizable, scalable decision aid component we call Veterans Like Me (VLme). VLme mines EHR data to present the outcomes of individuals "like you" on different treatments to the user. These outcome are presented through a combination of an icon array and simulated narratives. Twenty-six patients participated in semi-structured interviews intended to elicit feedback on the tool's functional and interface design. The interview focused on the filters users desired with which to make cases similar to them, the kinds of outcomes they wanted presented, and their envisioned use of the tool. The interview also elicited participants information needs and salient factors related to the therapeutic decision. The interview transcripts were analyzed using an iteratively refined coding schema and content analysis. . Participants generally expressed enthusiasm for the tool's design and functionality. Our analysis identified desired filters for users to view patients like themselves, outcome types that should be included in future iterations of the tool (e.g. patient reported outcomes), and information needs that need to be addressed for patients to effectively participate in shared decision making. Implications for the integration of our findings into the design of patient decision aids are discussed.

[1]  M. Britto,et al.  Real life clinic visits do not match the ideals of shared decision making. , 2014, The Journal of pediatrics.

[2]  Qing Zeng-Treitler,et al.  The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study , 2016, BMC Research Notes.

[3]  Brian J Zikmund-Fisher,et al.  All Stories Are Not Alike , 2013, Medical decision making : an international journal of the Society for Medical Decision Making.

[4]  Robyn Tamblyn,et al.  Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses , 2016, Journal of medical Internet research.

[5]  Z. Eisikovits,et al.  Physician as partner or salesman? Shared decision-making in real-time encounters. , 2009, Social science & medicine.

[6]  M. Chin,et al.  Race and shared decision-making: perspectives of African-Americans with diabetes. , 2010, Social science & medicine.

[7]  A. McGuire,et al.  Missed Expectations?: Physicians’ Views of Patients’ Participation in Medical Decision-Making , 2005, Medical care.

[8]  P. Ubel,et al.  The impact of the format of graphical presentation on health-related knowledge and treatment choices. , 2008, Patient education and counseling.

[9]  Amiram Gafni,et al.  What do we mean by partnership in making decisions about treatment? , 1999, BMJ.

[10]  G. Gigerenzer,et al.  Simple tools for understanding risks: from innumeracy to insight , 2003, BMJ : British Medical Journal.

[11]  Angela Fagerlin,et al.  Clarifying values: an updated review , 2013, BMC Medical Informatics and Decision Making.

[12]  Richard L Street,et al.  Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults. , 2011, Patient education and counseling.

[13]  Angela Coulter,et al.  A systematic development process for patient decision aids , 2013, BMC Medical Informatics and Decision Making.

[14]  L. Fraenkel,et al.  What are the Essential Elements to Enable Patient Participation in Medical Decision Making? , 2007, Journal of General Internal Medicine.

[15]  S. Larsson,et al.  Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women. , 2016, International journal of cardiology.

[16]  A. O'Connor,et al.  Using patient decision aids to promote evidence-based decision making , 2001, ACP journal club.

[17]  William Godolphin,et al.  Putting informed and shared decision making into practice , 2006, Health expectations : an international journal of public participation in health care and health policy.

[18]  A M Stiggelbout,et al.  Shared decision making: Concepts, evidence, and practice. , 2015, Patient education and counseling.

[19]  Aileen Clarke,et al.  Developing a quality criteria framework for patient decision aids: online international Delphi consensus process , 2006, BMJ : British Medical Journal.

[20]  G. Lip,et al.  CHADS2, CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention. , 2014, Thrombosis research.

[21]  L. Teixeira,et al.  Work ability and associated factors of Brazilian technical-administrative workers in education , 2016, BMC Research Notes.

[22]  France Légaré,et al.  Decision aids for people facing health treatment or screening decisions. , 2017, The Cochrane database of systematic reviews.

[23]  G. Gigerenzer,et al.  Using icon arrays to communicate medical risks: overcoming low numeracy. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.