Impact of sociodemographic patient characteristics on the efficacy of decision aids a patient-level meta-analysis of 7 randomized trials

Megan Coylewright, Megan Branda, Jonathan W. Inselman, Nilay D Shah, Erik Hess, Annie LeBlanc, Victor Manuel Montori, Henry H. Ting

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background-Decision aids (DAs) increase patient knowledge, reduce decisional conflict, and promote shared decision making (SDM). The extent to which they do so across diverse sociodemographic patient groups is unknown. Methods and Results-We conducted a patient-level meta-analysis of 7 randomized trials of DA versus usual care comprising 771 encounters between patients and clinicians discussing treatment options for chest pain, myocardial infarction, diabetes mellitus, and osteoporosis. Using a random effects model, we examined the impact of sociodemographic patient characteristics (age, sex, education, income, and insurance status) on the outcomes of knowledge transfer, decisional conflict, and patient involvement in SDM. Because of small numbers of people of color in the study population, we were not powered to investigate the role of race. Most patients were aged <65 years (61%), white (94%), and women (59%); two thirds had greater than a high school education. Compared with usual care, DA patients gained knowledge, were more likely to know their risk, and had less decisional conflict along with greater involvement in SDM. These gains were largely consistent across sociodemographic patient groups, with DAs demonstrating similar efficacy when used with vulnerable patients such as the elderly and those with less income and less formal education. Differences in efficacy were found only in knowledge of risk in 1 subgroup, with greater efficacy among those with higher education (35% versus 18%; P=0.02). Conclusions-In this patient-level meta-analysis of 7 randomized trials, DAs were efficacious across diverse sociodemographic groups as measured by knowledge transfer, decisional conflict, and patient involvement in SDM. To the extent that DAs increase patient knowledge and participation in SDM, they have potential to impact health disparities related to these factors.

Original languageEnglish (US)
Pages (from-to)360-367
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume7
Issue number3
DOIs
StatePublished - 2014

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Decision Support Techniques
Meta-Analysis
Decision Making
Patient Participation
Education
Insurance Coverage
Sex Education
Chest Pain
Osteoporosis
Diabetes Mellitus
Color
Myocardial Infarction

Keywords

  • Decision making
  • Decision support techniques

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of sociodemographic patient characteristics on the efficacy of decision aids a patient-level meta-analysis of 7 randomized trials. / Coylewright, Megan; Branda, Megan; Inselman, Jonathan W.; Shah, Nilay D; Hess, Erik; LeBlanc, Annie; Montori, Victor Manuel; Ting, Henry H.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 7, No. 3, 2014, p. 360-367.

Research output: Contribution to journalArticle

Coylewright, Megan ; Branda, Megan ; Inselman, Jonathan W. ; Shah, Nilay D ; Hess, Erik ; LeBlanc, Annie ; Montori, Victor Manuel ; Ting, Henry H. / Impact of sociodemographic patient characteristics on the efficacy of decision aids a patient-level meta-analysis of 7 randomized trials. In: Circulation: Cardiovascular Quality and Outcomes. 2014 ; Vol. 7, No. 3. pp. 360-367.
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abstract = "Background-Decision aids (DAs) increase patient knowledge, reduce decisional conflict, and promote shared decision making (SDM). The extent to which they do so across diverse sociodemographic patient groups is unknown. Methods and Results-We conducted a patient-level meta-analysis of 7 randomized trials of DA versus usual care comprising 771 encounters between patients and clinicians discussing treatment options for chest pain, myocardial infarction, diabetes mellitus, and osteoporosis. Using a random effects model, we examined the impact of sociodemographic patient characteristics (age, sex, education, income, and insurance status) on the outcomes of knowledge transfer, decisional conflict, and patient involvement in SDM. Because of small numbers of people of color in the study population, we were not powered to investigate the role of race. Most patients were aged <65 years (61{\%}), white (94{\%}), and women (59{\%}); two thirds had greater than a high school education. Compared with usual care, DA patients gained knowledge, were more likely to know their risk, and had less decisional conflict along with greater involvement in SDM. These gains were largely consistent across sociodemographic patient groups, with DAs demonstrating similar efficacy when used with vulnerable patients such as the elderly and those with less income and less formal education. Differences in efficacy were found only in knowledge of risk in 1 subgroup, with greater efficacy among those with higher education (35{\%} versus 18{\%}; P=0.02). Conclusions-In this patient-level meta-analysis of 7 randomized trials, DAs were efficacious across diverse sociodemographic groups as measured by knowledge transfer, decisional conflict, and patient involvement in SDM. To the extent that DAs increase patient knowledge and participation in SDM, they have potential to impact health disparities related to these factors.",
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