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Combining multiple treatment comparisons with personalized patient preferences: a randomized trial of an interactive platform for statin treatment selection

Hopkin, Gareth, Au, Anson, Collier, Verena Jane, Yudkin, John S, Basu, Sanjay and Naci, Huseyin (2019) Combining multiple treatment comparisons with personalized patient preferences: a randomized trial of an interactive platform for statin treatment selection. Medical Decision Making. ISSN 0272-989X (In Press)

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Abstract

Background. Patients and clinicians are often required to make trade-offs between the relative benefits and harms of multiple treatment options. Combining network meta-analysis results with user preferences can be useful when choosing among several treatment alternatives. Objective. Using cholesterol-lowering statin drugs as a case study, we aimed to determine whether an interactive web-based platform that combines network meta-analysis findings with patient preferences had an effect on the decision making process in a general population sample. Method. This was a pilot parallel randomized controlled trial. Between December 2017 and January 2018, we used Amazon’s Mechanical Turk to recruit participants over the age of 18 residing in the United States. 349 participants were randomly allocated to see either the interactive tool (intervention) or a series of bar charts (control). Randomisation was computer-generated by the Qualtrics online platform using a 1:1 ratio for allocation and investigators were blinded to group assignment. The primary endpoint was decisional conflict and secondary endpoints included decision self-efficacy, preparation for decision making, and the overall ranking of statins. Results. 258 participants completed the trial and were included in the analysis. On the primary outcome, participants randomized to the interactive tool had significantly lower levels of decisional conflict than those in the control group (difference, -8.53; 95% CI, -12.96 to -4.11 on a 100-point scale; p=0.001). They also appeared to have higher levels of preparation for decision making (difference, 4.19; 95% CI, -0.24 to 8.63 on a 100-point scale; p=0.031). No difference was found for decision self-efficacy, although groups were statistically significantly different in how they ranked different statins. Conclusion. The findings of our proof-of-concept evaluation suggest that an interactive web-based tool combining published clinical evidence with individual preferences can reduce decisional conflict and better prepare individuals for decision making.

Item Type: Article
Additional Information: © 2019 The Authors
Divisions: Health Policy
Subjects: R Medicine > R Medicine (General)
Date Deposited: 05 Feb 2019 15:42
Last Modified: 23 Apr 2019 23:10
URI: http://eprints.lse.ac.uk/id/eprint/100029

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