Karine Toupin April1, Tamara Rader2, Gillian A Hawker2, Dawn Stacey2, Annette M O'Connor2, Vivian Welch2, Anne Lyddiatt2, Jessie McGowan2, J Carter Thorne2, Carol Bennett2, Jordi Pardo Pardo2, George A Wells2, Peter Tugwell2. 1. From the Children's Hospital of Eastern Ontario Research Institute; these departments of the University of Ottawa: Department of Pediatrics, Institute of Population Health, Centre for Global Health, School of Nursing, Bruyere Research Institute, Department of Medicine, Department of Epidemiology and Community Medicine, Cochrane Musculoskeletal Group and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Department of Medicine, University of Toronto, Toronto; Women's College Hospital, and Women's College Research Institute, Toronto; Division of Rheumatology and The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario, Canada.K. Toupin April, PhD, Associate Scientist, Children's Hospital of Eastern Ontario Research Institute, Assistant Professor, Department of Pediatrics, University of Ottawa; T. Rader, MLIS, Institute of Population Health, Trials Search Coordinator and Knowledge Translation Specialist, University of Ottawa; G.A. Hawker, MD, FRCPC, Chair, Department of Medicine, University of Toronto, Women's College Hospital, Senior Scientist, Women's College Research Institute; D. Stacey, RN, PhD, Full Professor, School of Nursing, University of Ottawa, and Scientist at the Ottawa Hospital Research Institute; J. Pardo Pardo, Managing Editor, Cochrane Musculoskeletal Group, University of Ottawa, Ottawa Hospital Research Institute; A.M. O'Connor, PhD, Emeritus Professor, School of Nursing, University of Ottawa; V. Welch, PhD, Bruyere Research Institute, University of Ottawa, Deputy Director, Institute of Population Health, Centre for Global Health, University of Ottawa; A. Lyddiatt, Consumer Editor, Cochrane Musculoskeletal Group, University of Ottawa; J. McGowan, MLIS, PhD, AHIP, Adjunct Professor, Department of Medicine, University of Ottawa; J.C. Thorne, MD, FRCP, FACP, Chief of the Division of Rheumatology and Director of The Arthritis Program, Southlake Regional Health Centre; C. Bennett, PT, MSc, Ottawa Hospital Research Institute; G.A. Wells, PhD, Professor, Department of Epidemiology and Community Medicine, University of Ottawa; P. Tugwell, MSc, MD, FRCPC, FCAHS, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Institute of Population Health, Centre for Global Health, University of Ottawa. ktoupin@cheo.on.ca. 2. From the Children's Hospital of Eastern Ontario Research Institute; these departments of the University of Ottawa: Department of Pediatrics, Institute of Population Health, Centre for Global Health, School of Nursing, Bruyere Research Institute, Department of Medicine, Department of Epidemiology and Community Medicine, Cochrane Musculoskeletal Group and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Department of Medicine, University of Toronto, Toronto; Women's College Hospital, and Women's College Research Institute, Toronto; Division of Rheumatology and The Arthritis Program, Southlake Regional Health Centre, Newmarket, Ontario, Canada.K. Toupin April, PhD, Associate Scientist, Children's Hospital of Eastern Ontario Research Institute, Assistant Professor, Department of Pediatrics, University of Ottawa; T. Rader, MLIS, Institute of Population Health, Trials Search Coordinator and Knowledge Translation Specialist, University of Ottawa; G.A. Hawker, MD, FRCPC, Chair, Department of Medicine, University of Toronto, Women's College Hospital, Senior Scientist, Women's College Research Institute; D. Stacey, RN, PhD, Full Professor, School of Nursing, University of Ottawa, and Scientist at the Ottawa Hospital Research Institute; J. Pardo Pardo, Managing Editor, Cochrane Musculoskeletal Group, University of Ottawa, Ottawa Hospital Research Institute; A.M. O'Connor, PhD, Emeritus Professor, School of Nursing, University of Ottawa; V. Welch, PhD, Bruyere Research Institute, University of Ottawa, Deputy Director, Institute of Population Health, Centre for Global Health, University of Ottawa; A. Lyddiatt, Consumer Editor, Cochrane Musculoskeletal Group, University of Ottawa; J. McGowan, MLIS, PhD, AHIP, Adjunct Professor, Department of Medicine, University of Ottawa; J.C. Thorne, MD, FRCP, FACP, Chief of the Division of Rheumatology and Director of The Arthritis Program, Southlake Regional Health Centre; C. Bennett, PT, MSc, Ottawa Hospital Research Institute; G.A. Wells, PhD, Professor, Department of Epidemiology and Community Medicine, University of Ottawa; P. Tugwell, MSc, MD, FRCPC, FCAHS, Professor, Department of Medicine, Faculty of Medicine, University of Ottawa, Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Institute of Population Health, Centre for Global Health, University of Ottawa.
Abstract
OBJECTIVE: To develop an innovative stepped patient decision aid (StDA) comparing the benefits and harms of 13 nonsurgical treatment options for managing osteoarthritis (OA) and to evaluate its acceptability and effects on informed decision making. METHODS: Guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards, the process involved (1) developing a decision aid with evidence on 13 nonsurgical treatments from the 2012 American College of Rheumatology OA clinical practice guidelines; and (2) interviewing patients with OA and healthcare providers to test its acceptability and effects on knowledge and decisional conflict. RESULTS: The StDA helped make the decision explicit, and presented evidence on 13 OA treatments clustered into 5 steps or levels according to their benefits and harms. Probabilities of benefits and harms were presented using pictograms of 100 faces formatted to allow comparisons across sets of options. It also included a values clarification exercise and knowledge test. Feedback was obtained from 49 patients and 7 healthcare providers. They found that the StDA presented evidence in a clear manner, and helped patients clarify their values and make an informed decision. Some participants found that there was too much information and others said that there was not enough on each treatment option. CONCLUSION: This innovative StDA allows patients to consider both the evidence and their values for multiple options. The findings are being used to revise and plan future evaluation. The StDA is an example of how research evidence in guidelines can be implemented in practice.
OBJECTIVE: To develop an innovative stepped patient decision aid (StDA) comparing the benefits and harms of 13 nonsurgical treatment options for managing osteoarthritis (OA) and to evaluate its acceptability and effects on informed decision making. METHODS: Guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards, the process involved (1) developing a decision aid with evidence on 13 nonsurgical treatments from the 2012 American College of Rheumatology OA clinical practice guidelines; and (2) interviewing patients with OA and healthcare providers to test its acceptability and effects on knowledge and decisional conflict. RESULTS: The StDA helped make the decision explicit, and presented evidence on 13 OA treatments clustered into 5 steps or levels according to their benefits and harms. Probabilities of benefits and harms were presented using pictograms of 100 faces formatted to allow comparisons across sets of options. It also included a values clarification exercise and knowledge test. Feedback was obtained from 49 patients and 7 healthcare providers. They found that the StDA presented evidence in a clear manner, and helped patients clarify their values and make an informed decision. Some participants found that there was too much information and others said that there was not enough on each treatment option. CONCLUSION: This innovative StDA allows patients to consider both the evidence and their values for multiple options. The findings are being used to revise and plan future evaluation. The StDA is an example of how research evidence in guidelines can be implemented in practice.