Communicating Benefits

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Communicating Benefits Risks with Decision Aids

• A OConnor R.N., Ph.D.
• University of Ottawa
• Canada

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Key Points

• Unprecedented need for decision support
• One solution Decision aids
• Examples of just in time decision aids from
  other trials

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1. Unprecedented Need

• WHI stimulates
• millions to ask
• SHOULD I STOP?
• SHOULD I START?

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Carols Dianas decisions 52 yrs old, severe
menopausal symptoms
Personal Importance
Personal Importance

• Benefit
• menopause
• symptom
• relief

• Extra yearly risk in 1000 treated women like
  them
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50 year old Carols values

• Benefit
• symptom
• relief

• Extra yearly risk in 1000 treated women
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Personal Importance
Personal Importance


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50 year old Dianas values
Personal Importance
Personal Importance

• Benefit
• symptom
• relief

• Extra yearly risk in 1000 treated women
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2. Solution Decision Aids
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International Cochrane Definition BMJ 1999
319731 -734 Cochrane Library

• adjuncts to counseling
• for specific, deliberated choices
• describes options outcomes relevant to persons
  health status

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Additional Elements

• information on condition
• outcome probabilities- tailored to pt
• values clarification exercise
• information on others experiences
• guidance in the steps of decision making and
  communication

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Do Decision Aids Work????

• Results from 30 randomized controlled trials

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Decision Aids on HRT

• Over 11 available
• All need revision
• None available just in time of greatest need

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3. Just-In-Time Strategies
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SPAFIII Study JAMA 1999 282737-743

• End of trial, participants faced choice to
  continue aspirin or switch to warfarin
• ½ randomly assigned to usual debriefing
• ½ randomly assigned to usual debriefing plus
  decision aid

• Those debriefed with decision aid had
• Better knowledge
• More realistic expectations
• Less decisional conflict
• Fewer undecided
• Less likely to take warfarin
• No effect on satisfaction or adherence to chosen
  therapy

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National Surgical Adjuvant Breast and Bowel
Project P-1 Breast Cancer Prevention with
Tamoxifen

• Healthy, high risk, women now had the option of
  using tamoxifen after considering potential
  benefits/risks
• Breast cancer risk assessment tool developed for
  providers and on website (with background
  information on Tamoxifen benefits/harms)
• http//bcra.nci.nih.gov/brc/learnmore.htm

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Conclusions

• Decision aids improve quality of decision making
• Previous success using them following trials
• Useful for current WHI trial and future trial
  releases.

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Decision aids website

• www.ohri.ca/programs/
• clinical_epidemiology/
• ohdec/decision aids