A tale of two studies: the importance of setting, subjects and context in two randomized, controlled trials of a web-based decision support for perimenopausal and postmenopausal health decisions
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Medical Subject Headings
Aged; Computer-Assisted Instruction; Conflict (Psychology); *Decision Support Techniques; Estrogen Replacement Therapy; Female; Health Knowledge, Attitudes, Practice; Humans; Internet; Middle Aged; Pamphlets; Patient Education as Topic; *Patient Satisfaction; Perimenopause; Postmenopause; Questionnaires; Risk Assessment; Teaching Materials; Uncertainty; United States; Women
Community Health and Preventive Medicine | Health Services Research | Primary Care
OBJECTIVE: Knowledge relevant to women's peri- and postmenopausal health decisions has been evolving rapidly. Web-based decision supports can be rapidly updated and have the potential to improve the quality of patients' decisions. We developed and tested a web-based decision support for peri- and postmenopausal health decisionmaking.
METHODS: We recruited 409 women aged 45-75 for one randomized, controlled trial and 54 women with an upcoming clinic appointment for a subsequent trial. Women were randomized to use the web-based decision support versus a printed brochure (first trial) and usual care (second trial). Outcomes were changes in decisional satisfaction, decisional conflict, and knowledge, both within each trial and compared across the trials.
RESULTS: Intervention subjects had greater increases in decisional satisfaction in the second trial and knowledge in both trials. A high dropout rate among women randomized to the website in the first trial effectively negated benefits in that trial, but not in the second.
CONCLUSIONS: The utility of this web-based decision support in two trials depended on a number of factors that appear related to the urgency of making a decision.
PRACTICE IMPLICATIONS: Decision aids should be targeted to patients actively trying to make a decision.