Andrea J Loizeau1,2,3, Nathan Theill1,2,4, Simon M Cohen3, Stefanie Eicher1,2, Susan L Mitchell3,5, Silvio Meier2,6, Michelle McDowell7, Mike Martin1,2,6, Florian Riese1,4. 1. University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland. 2. Center for Gerontology, University of Zurich, Zurich, Switzerland. 3. Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA. 4. Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland. 5. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 6. Department of Psychology, University of Zurich, Zurich, Switzerland. 7. Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany.
Abstract
Background: fact Boxes are decision support tools that can inform about treatment effects. Objectives: to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods: participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results:participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = -8.35, 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration (b = -6.02, 95% CI, -9.84, -2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. Trial registration: FORSbase (12091).
RCT Entities:
Background: fact Boxes are decision support tools that can inform about treatment effects. Objectives: to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design: randomized controlled trial. Setting: Swiss-German region of Switzerland. Subjects: two hundred thirty-two participants (64 physicians, 100 relatives of dementiapatients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention: two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods:participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results:participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = -8.35, 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration (b = -6.02, 95% CI, -9.84, -2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions: fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. Trial registration: FORSbase (12091).
Authors: H Roeline W Pasman; Bregje D Onwuteaka-Philipsen; Didi M W Kriegsman; Marcel E Ooms; Miel W Ribbe; Gerrit van der Wal Journal: Arch Intern Med Date: 2005 Aug 8-22
Authors: Seth F Einterz; Robin Gilliam; Feng Chang Lin; J Marvin McBride; Laura C Hanson Journal: J Am Med Dir Assoc Date: 2014-02-06 Impact factor: 4.669
Authors: Jenny T van der Steen; David R Mehr; Robin L Kruse; Ashley K Sherman; Richard W Madsen; Ralph B D'Agostino; Marcel E Ooms; Gerrit van der Wal; Miel W Ribbe Journal: J Clin Epidemiol Date: 2006-05-23 Impact factor: 6.437
Authors: Susan L Mitchell; Jennifer A Palmer; Angelo E Volandes; Laura C Hanson; Daniel Habtemariam; Michele L Shaffer Journal: J Pain Symptom Manage Date: 2017-08-08 Impact factor: 3.612
Authors: Tessa van der Maaden; Jenny T van der Steen; Henrica C W de Vet; Cees M P M Hertogh; Raymond T C M Koopmans Journal: J Am Med Dir Assoc Date: 2015-09-26 Impact factor: 4.669
Authors: Susan L Mitchell; Michele L Shaffer; Simon Cohen; Laura C Hanson; Daniel Habtemariam; Angelo E Volandes Journal: JAMA Intern Med Date: 2018-07-01 Impact factor: 21.873
Authors: Andrea Jutta Loizeau; Simon M Cohen; Susan L Mitchell; Nathan Theill; Stefanie Eicher; Mike Martin; Florian Riese Journal: Neurodegener Dis Date: 2019-04-23 Impact factor: 2.977