Clinician's use of the Statin Choice decision aid in patients with diabetes: A videographic study nested in a randomized trial

Roberto Abadie, Audrey J. Weymiller, Jon Tilburt, Nilay D. Shah, Cathy Charles, Amiram Gafni, Victor M. Montori

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Objective To describe how clinicians use decision aids. Background A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters. Design Two researchers working independently and in duplicate reviewed and coded the 22 encounter videos. Setting and participants Twenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation. Main outcome measures Proportion and nature of unintended use of the Statin Choice decision aid. Results We found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters. Conclusions Unintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.

Original languageEnglish (US)
Pages (from-to)492-497
Number of pages6
JournalJournal of Evaluation in Clinical Practice
Volume15
Issue number3
DOIs
StatePublished - Jun 1 2009

Keywords

  • Decision aid
  • Diabetes
  • Randomized trial
  • Shared decision making
  • Video analyses

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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