Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis
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Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making.
The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision-making. Two separate surveys were conducted: one in the control group and one in the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and were asked to choose between three hypothetical drug treatments, which varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief “washout” period, members of the control group made a second treatment choice after reviewing the balance sheet again, while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices, participants rated their degree of confidence in their choice on a 1 to 10 scale.
Members of the dashboard intervention group were more likely to change their choice of preferred drug (10.2 versus 7.5 %; p = 0.054) and had a larger increase in decision confidence than the control group (0.67 versus 0.075; p < 0.03). There were no statistically significant between-group differences in decisional conflict or decision aid acceptability.
These findings suggest that clinical decision dashboards may be an effective point-of-care decision-support tool. Further research to explore this possibility is warranted.
KeywordsBalance Sheet Decision Confidence Decisional Conflict Decisional Conflict Scale Prefer Treatment Option
This work was supported in part by Grant 1 K24 RR024198-02 from the National Heart, Lung, and Blood Institute. The funding agency did not influence the design, conduct, or reporting of the study.
James Dolan helped design, conduct, analyze, and report the study presented here. He received grant-related salary support and has no other conflicts of interest to report. He is the overall guarantor of the study description and results as presented.
Peter Veazie helped design, conduct, analyze, and report the study presented here. He also received grant-related salary support and has no other conflicts of interest to report.
Shirley X. L. Li played a major role in conducting this study. The authors are grateful for her contributions.
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