Development and Pilot Testing of Decision Aid for Shared Decision Making in Barrett's Esophagus with Low-Grade Dysplasia

Rajesh Krishnamoorthi, Ian Hargraves, Naveen Gopalakrishnan, Christopher H. Blevins, Harshith Priyan, Michele L. Johnson, Kristyn A. Maixner, Kenneth K. Wang, David A. Katzka, Jayant A. Talwalkar, Annie Leblanc, Prasad G. Iyer

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalJournal of clinical gastroenterology
Volume55
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Barrett's esophagus with low-grade dysplasia
  • decision aid
  • shared decision making

ASJC Scopus subject areas

  • Gastroenterology

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