TY - JOUR
T1 - Development and Pilot Testing of Decision Aid for Shared Decision Making in Barrett's Esophagus with Low-Grade Dysplasia
AU - Krishnamoorthi, Rajesh
AU - Hargraves, Ian
AU - Gopalakrishnan, Naveen
AU - Blevins, Christopher H.
AU - Priyan, Harshith
AU - Johnson, Michele L.
AU - Maixner, Kristyn A.
AU - Wang, Kenneth K.
AU - Katzka, David A.
AU - Talwalkar, Jayant A.
AU - Leblanc, Annie
AU - Iyer, Prasad G.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Goals:To develop an encounter decision aid [Barrett's esophagus Choice (BE-Choice)] for patients and clinicians to engage in shared decision making (SDM) for management of BE with low-grade dysplasia (BE-LGD) and assess its impact on patient-important outcomes.Background:Currently, there are 2 strategies for management of BE-LGD - endoscopic surveillance and ablation. SDM can help patients decide on their preferred management option.Study:Phase-I: Patients and clinicians were engaged in a user-centered design approach to develop BE-Choice. Phase-I included review of evidence on BE-LGD management, observation of usual care (UC), creation, field-testing, and iterative development of BE-Choice in clinical settings. Phase-II: Impact of BE-Choice on patient-important outcomes (patient knowledge, decisional conflict, and patient involvement in decision making) was assessed using a controlled before-after study design (UC vs. BE-Choice).Results:Phase-I: Initial prototype was designed with observation of 8 clinical encounters. With field-testing, 3 successive iterations were made before finalizing BE-Choice. BE-Choice was paper based and fulfilled the qualifying criteria of International patient decision aid standards. Phase II: 29 patients were enrolled, 8 to UC and 21 to BE-Choice. Compared with UC, use of BE-Choice improved patient knowledge (90.4% vs. 70.5%; P=0.03), decisional comfort (89.6 vs. 71.9; P=0.01), and patient involvement (OPTION score: 27.1 vs. 19.2; P=0.01).Conclusions:BE-Choice is a feasible and effective decision aid to promote SDM in the management of BE-LGD. On pilot testing, BE-Choice had promising impact on patient-important outcomes. A larger multicenter trial is needed to confirm our results and promote widespread use of BE-Choice.
AB - Goals:To develop an encounter decision aid [Barrett's esophagus Choice (BE-Choice)] for patients and clinicians to engage in shared decision making (SDM) for management of BE with low-grade dysplasia (BE-LGD) and assess its impact on patient-important outcomes.Background:Currently, there are 2 strategies for management of BE-LGD - endoscopic surveillance and ablation. SDM can help patients decide on their preferred management option.Study:Phase-I: Patients and clinicians were engaged in a user-centered design approach to develop BE-Choice. Phase-I included review of evidence on BE-LGD management, observation of usual care (UC), creation, field-testing, and iterative development of BE-Choice in clinical settings. Phase-II: Impact of BE-Choice on patient-important outcomes (patient knowledge, decisional conflict, and patient involvement in decision making) was assessed using a controlled before-after study design (UC vs. BE-Choice).Results:Phase-I: Initial prototype was designed with observation of 8 clinical encounters. With field-testing, 3 successive iterations were made before finalizing BE-Choice. BE-Choice was paper based and fulfilled the qualifying criteria of International patient decision aid standards. Phase II: 29 patients were enrolled, 8 to UC and 21 to BE-Choice. Compared with UC, use of BE-Choice improved patient knowledge (90.4% vs. 70.5%; P=0.03), decisional comfort (89.6 vs. 71.9; P=0.01), and patient involvement (OPTION score: 27.1 vs. 19.2; P=0.01).Conclusions:BE-Choice is a feasible and effective decision aid to promote SDM in the management of BE-LGD. On pilot testing, BE-Choice had promising impact on patient-important outcomes. A larger multicenter trial is needed to confirm our results and promote widespread use of BE-Choice.
KW - Barrett's esophagus with low-grade dysplasia
KW - decision aid
KW - shared decision making
UR - http://www.scopus.com/inward/record.url?scp=85097210531&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097210531&partnerID=8YFLogxK
U2 - 10.1097/MCG.0000000000001319
DO - 10.1097/MCG.0000000000001319
M3 - Article
C2 - 32040049
AN - SCOPUS:85097210531
SN - 0192-0790
VL - 55
SP - 36
EP - 42
JO - Journal of clinical gastroenterology
JF - Journal of clinical gastroenterology
IS - 1
ER -