Marian E Betz1,2, Linda L Hill3, Nicole R Fowler4,5, Carolyn DiGuiseppi6, S Duke Han7, Rachel L Johnson8, Lauren Meador1, Faris Omeragic1, Ryan A Peterson8, Daniel D Matlock2,9. 1. Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA. 2. Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA. 3. Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA. 4. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. 5. Indiana University Center for Aging Research, Indianapolis, Indiana, USA. 6. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 7. Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA. 8. Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA. 9. Division of Geriatric Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA.
Abstract
BACKGROUND: Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. METHODS: This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores. RESULTS: Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations. CONCLUSIONS: The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility. TRIAL REGISTRATION: ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.
BACKGROUND: Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality. METHODS: This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores. RESULTS: Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations. CONCLUSIONS: The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility. TRIAL REGISTRATION: ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.
Authors: Dawn Stacey; France Légaré; Nananda F Col; Carol L Bennett; Michael J Barry; Karen B Eden; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Anne Lyddiatt; Richard Thomson; Lyndal Trevena; Julie H C Wu Journal: Cochrane Database Syst Rev Date: 2014-01-28
Authors: Karen R Sepucha; Cornelia M Borkhoff; Joanne Lally; Carrie A Levin; Daniel D Matlock; Chirk Jenn Ng; Mary E Ropka; Dawn Stacey; Natalie Joseph-Williams; Celia E Wills; Richard Thomson Journal: BMC Med Inform Decis Mak Date: 2013-11-29 Impact factor: 2.796