Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary

Abstract

Objective To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use. Design Randomised controlled trial. Setting 33 general practices in the United Kingdom. Participants 112 men with benign prostatic hypertrophy. Intervention Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. Outcome measures Patients' and general practitioners' perceptions of who made the decision, decisional conflict scores, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status. Results Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%, 95% confidence interval 14% to 41%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months (2.3 v 2.6; − 0.3, − 0.5 to − 0.1, P < 0.01) and this was maintained at nine months. No differences were found between the groups for anxiety, general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment). Conclusions The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply by the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

“…In addition to high-level evidence and practice guidelines, variation may decrease with the development of methods for increasing patient involvement in their own care [14] by diminishing the influence of individual physician attitudes. Decision aids-tools to facilitate the shared decision-making process, ie, increasing patient participation [20]-in particular have resulted in a 20% decrease in proceeding with elective surgeries in other clinical areas such as knee replacement [11], prostatectomy for benign prostatic hypertrophy [15], and back surgery for herniated discs [6]. Decision aids that enhance patient involvement in decision-making by providing them with complete, balanced, evidence-based information, which they can review at their own pace, may decrease decisional conflict, that is, uncertainty about which course of action to take [20].…”

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

“…Seventy-six percent of patients who preferred shared decision-making had lower scores on the DASH questionnaire compared with those who preferred a fully active or fully passive role [9]. There is some evidence that decision aids can help patients achieve their preferred role in decision-making [14,19]. In general, patients who actively contribute to their health care have better functional outcome, choose less invasive treatments, and are more satisfied with their options [5,8,11,18].…”

The utility of a multimedia education program for prostate cancer patients: a formative evaluation

“…Multimedia programs for patients with benign prostatic hyperplasia have reported positive results for reducing self-assessed prostate symptoms (van Schaik et al, 1999) and facilitating SDM Shepperd et al, 1995;Wagner et al, 1995;Murray et al, 2001). Pilot studies of MMPs for prostate cancer have reported patient satisfaction with navigability, layout and content (Jenkinson et al, 1998;Brink et al, 2000).…”