Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary

doi:10.1136/bmj.323.7311.493

BMJ 2001;323:493 ( 1 September )

Primary care

Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care

Elizabeth Murray, senior lecturer in primary health care, ^a Hilary Davis, research fellow, ^a Sharon See Tai, senior research fellow, ^a Angela Coulter, chief executive, ^b Alastair Gray, director, ^c Andy Haines, professor of primary care. ^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 benignprostatic hypertrophy influences decision making, health outcomes,and resourceuse.
Design: Randomised controlledtrial.
Setting: 33 general practices in the UnitedKingdom.
Participants: 112 men with benign prostatichypertrophy.
Intervention: Patients' decision aid consisting of an interactivemultimedia programme with booklet and printedsummary.
Outcome measures: Patients' and general practitioners' perceptionsof who made the decision, decisional conflict scores, treatmentchoice and prostatectomy rate, American Urological Associationsymptom scale, costs, anxiety, utility, and general healthstatus.
Results: Both patients and general practitioners foundthe decision aid acceptable. A higher proportion of patients (32%v 4%; mean difference 28%, 95% confidence interval 14% to 41%)and their general practitioners (46% v 25%; 21%, 3% to 40%) perceivedthat treatment decisions had been made mainly or only by patientsin the intervention group compared with the control group. Patientsin the intervention group had significantly lower decisional conflictscores than those in the control group at three months (2.3 v2.6; $-$ 0.3, $-$ 0.5 to $-$ 0.1, P<0.01) and this was maintained at ninemonths. No differences were found between the groups for anxiety,general health status, prostatic symptoms, utility, or costs (excludingcosts associated with the video discequipment).
Conclusions: The decision aid reduced decisional conflictin men with benign prostatic hypertrophy, and the patients playeda more active part in decision making. Such programmes could bedelivered cheaply by the internet, and there are good argumentsfor coordinated investment in them, particularly for conditionsin which patient utilities areimportant.

What is already known on this topic
Patients want more information about their condition 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 highly 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 less anxious than control patients

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

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