Encounter decision aid vs. clinical decision support or usual care to support patient-centered treatment decisions in osteoporosis: The Osteoporosis Choice randomized trial II

Annie LeBlanc, Amy T. Wang, Kirk Wyatt, Megan E. Branda, Nilay D Shah, Holly Van Houten, Laurie Pencille, Robert Wermers, Victor Manuel Montori

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose: Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown. Methods: Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates. Results: We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01), improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively), had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001). Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer). There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07); medication adherence at 6 months was no different across arms. Conclusion: Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results. Trial Registration: clinical trials.gov NCT00949611.

Original languageEnglish (US)
Article numbere0128063
JournalPLoS One
Volume10
Issue number5
DOIs
StatePublished - May 26 2015

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Clinical Decision Support Systems
Decision Support Techniques
osteoporosis
decision support systems
Osteoporosis
Diphosphonates
Decision making
Decision Making
decision making
Therapeutics
Patient Participation
osteopenia
Medication Adherence
Metabolic Bone Diseases
Risk Reduction Behavior
risk reduction
Prescriptions
clinical trials
Clinical Trials

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Encounter decision aid vs. clinical decision support or usual care to support patient-centered treatment decisions in osteoporosis : The Osteoporosis Choice randomized trial II. / LeBlanc, Annie; Wang, Amy T.; Wyatt, Kirk; Branda, Megan E.; Shah, Nilay D; Van Houten, Holly; Pencille, Laurie; Wermers, Robert; Montori, Victor Manuel.

In: PLoS One, Vol. 10, No. 5, e0128063, 26.05.2015.

Research output: Contribution to journalArticle

LeBlanc, Annie ; Wang, Amy T. ; Wyatt, Kirk ; Branda, Megan E. ; Shah, Nilay D ; Van Houten, Holly ; Pencille, Laurie ; Wermers, Robert ; Montori, Victor Manuel. / Encounter decision aid vs. clinical decision support or usual care to support patient-centered treatment decisions in osteoporosis : The Osteoporosis Choice randomized trial II. In: PLoS One. 2015 ; Vol. 10, No. 5.
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