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PRIMARY CARE: Elizabeth Murray, Hilary Davis, Sharon See Tai, Angela Coulter, Alastair Gray, and Andy Haines Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care BMJ 2001; 323: 493 [Abstract] [Full text]

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Multimedia decision support: an alternative interpretation

Trisha Greenhalgh   (3 September 2001)

Multimedia decision support: an alternative interpretation 3 September 2001
Trisha Greenhalgh, Professor of Primary Health Care University College London Send response to journal: Re: Multimedia decision support: an alternative interpretation	The results of Murray et al's two studies on interactive multimedia decision aids are compatible with the conclusions drawn by the authors(1;2) and by the accompanying editorial (3) - that such products are generally acceptable; that they lead to a substantial decrease in patients' decisional conflict; that the interactive nature of the software allows information to be personalised; that high-technology decision aids, though expensive now, are likely to cost less per case in the future; that it does not much matter that the technology was obsolete and the evidence had moved on by the time the papers came to press; and that such technologies should be introduced more widely. However, the results are also compatible with the opposite conclusion - that most patients prefer not to use (or even try out) multimedia decision support aids (hence the disappointingly low recruitment despite a commendable effort by the research team and participating GPs (1)); that the absolute difference made to decisional conflict and to the actual decision made was small; that the "interactivity" provided only limited personalisation of the information for variables such as age but could not begin to mirror the complexity of real-life decision-making; that the apparent acceptability and usefulness of multimedia decision aids could be explained by the well described Hawthorne effect of new technologies in educational contexts (4); and that the favourable economic evaluations presented failed to take into account the massive cost and lengthy time course of developing the technology in the first place. Murray et al's results also demonstrate that both high-technology software and the information they contain have a high chance of being obsolete by the time they are used. There is an emerging social science of information technology which warns against extrapolating from resource- rich, quantitative and highly contextual research studies to the messy and under-resourced reality of real life (5). The introduction of high-tech, "interactive" decision aids is a complex intervention (6); the next phase of research trials must surely include in-depth qualitative studies on precisely how and why patients and health professionals use (or, against prediction, choose not to use) these products. Reference List 1. Murray E, Davis H, See Tai S, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care. BMJ 2001;323:494-6. 2. Murray E, Davis H, See Tai S, Coulter A, Gray A, Haines A. Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. BMJ 2001;323:490-3. 3. Deyo RA. A key medical decision-maker: the patient. BMJ 2001;323:467-8. 4. Greenhalgh T. Computer assisted learning in undergraduate medical education. BMJ 2001;322:40-4. 5. Brown JS, Duguid P. The Social Life of Information . Cambridge, Mass : Harvard Business School Press, 2000. 6. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000;321:694-6.