BMJ 2001;323:490 ( 1 September )

Primary care

Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care

Elizabeth Murray, senior lecturer, a Hilary Davis, research fellow, a Sharon See Tai, senior research fellow, a Angela Coulter, director, b Alastair Gray, director, c Andy Haines, professor. a

a Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London N19 3UA, b Picker Institute Europe, Oxford OX1 1RX, c Health Economics Research Centre, University of Oxford, Oxford OX3 7LF

Correspondence to: E Murray elizabeth.murray{at}pcps.ucl.ac.uk

Objective: To determine whether a decision aid on hormone replacement therapy influences decision making and health outcomes.
Design: Randomised controlled trial.
Setting: 26 general practices in the United Kingdom.
Participants: 205 women considering hormone replacement therapy.
Intervention: Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary.
Outcome measures: Patients' and general practitioners' perceptions of who made the decision, decisional conflict, treatment choice, menopausal symptoms, costs, anxiety, and general health status.
Results: Both patients and general practitioners found the decision aid acceptable. At three months, mean scores for decisional conflict were significantly lower in the intervention group than in the control group (2.5 v 2.8; mean difference -0.3, 95% confidence interval -0.5 to -0.2); this difference was maintained during follow up. A higher proportion of general practitioners perceived that treatment decisions had been made "mainly or only" by the patient in the intervention group than in the control group (55% v 31%; 24%, 8% to 40%). At three months a lower proportion of women in the intervention group than in the control group were undecided about treatment (14% v 26%; -12%, -23% to -0.4%), and a higher proportion had decided against hormone replacement therapy (46% v 32%; 14%, 1% to 28%); these differences were no longer apparent by nine months. No differences were found between the groups for anxiety, use of health service resources, general health status, or utility. The higher costs of the intervention were largely due to the video disc technology used.
Conclusions: An interactive multimedia decision aid in the NHS would be popular with patients, reduce decisional conflict, and let patients play a more active part in decision making without increasing anxiety. The use of web based technology would reduce the cost of the intervention.


What is already known on this topic
Patients want more information about their conditions and treatment options, and many want to play an active part in decision making

Decision aids improve patients' knowledge of their conditions and treatment options

What this study adds
The decision aid was acceptable to both the patients and their general practitioners

Decisional conflict was reduced in the intervention group

Patients who viewed the programme played a more active part in the decision making process and were no more anxious than control patients

Such aids could be introduced throughout the NHS at relatively low cost by using the internet



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