Role of decision aid desgin in single event decision making

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Promoting Shared Decision Making Through a Tailored Decision Aid PROJECT SUMMARY Many medical decisions are preference-sensitive, with the best choice depending in part on patient attitudes towards the risks and benefits of treatment alternatives. For example, the best treatment for a man with localized prostate cancer may depend on how strongly he wants to avoid the chance of impotence, or on how determined he is to physically remove the cancer from his body. An ideal decision, therefore, will be made with full awareness of patient preferences. Research is needed to determine the best methods for helping patients communicate their preferences to their physicians. Using a two-phase strategy, we will test methods for increasing patients' willingness and ability to discuss their preferences and for improving the concordance between their desires for shared decision making and the type of participation they experience. In Phase I, we will conduct Internet studies to test several novel ways of tailoring a prostate cancer decision aid (DA), with the goal of identifying interventions that increase the perceived salience of patient preferences. After we have determined the best interventions, we will modify our current prostate cancer DA accordingly. Phase II will then compare this new tailored DA to our current untailored decision aid in men with newly diagnosed localized prostate cancer. This study will be conducted at two hospitals (University of Michigan and Ann Arbor VA) and will recruit men at the time of their prostate biopsy. Effectiveness of the tailored DA will be determined using both quantitative and qualitative methods. Primary quantitative outcome measures include self-efficacy and intentions for communicating treatment preferences to physician, preference for participating in the decision, concordance of desired and actual participation in the decision, and patients' perceptions of their interaction with their physicians. We will also analyze conversations between patients and physicians to examine whether the tailored DA has an impact on the interaction between patients and physicians (e.g., discussion of patients' preferences). Finally, we will use eye-tracking studies as another method of accessing patient engagement with the DA. The results of this study allow us to have unprecedented data about how to design DAs to improve patient-physician communication. This will result in patients making more informed decisions, which in turn could result in better physical and psychological outcomes for patients.