 |
|
Effects of Decision Aids for Menorrhagia on Treatment Choices, Health Outcomes, and Costs
A Randomized Controlled Trial
Andrew D. M. Kennedy, BSc;
Mark J. Sculpher, PhD;
Angela Coulter, PhD;
Nuala Dwyer, FRCOG;
Margaret Rees, FRCOG;
Keith R. Abrams, PhD;
Susan Horsley, RN;
Deborah Cowley, RN;
Christine Kidson, RN;
Catherine Kirwin, RN;
Caroline Naish, RN;
Gordon Stirrat, FRCOG
JAMA. 2002;288:2701-2708.
Context Decision aids can increase patient involvement in treatment decision making. However, questions remain regarding their effects and cost implications.
Objective To evaluate the effects of information, with and without a structured preference elicitation interview, on treatment choices, health outcomes, and costs.
Design, Setting, and Participants A randomized controlled trial with 2 years of follow-up. Between October 1996 and February 1998, 894 women with uncomplicated menorrhagia were recruited from 6 hospitals in southwest England. Women were randomized to the control group, information alone group (information), or information plus interview group (interview).
Interventions Women in both intervention groups were sent an information pack (a booklet and complementary videotape) 6 weeks before their specialist consultation. Immediately before their consultation, women in the interview group underwent structured interview, to clarify and elicit their preferences.
Main Outcome Measures Self-reported health status was the main outcome; secondary outcomes included treatments received and costs. Cost analyses adopted a UK health service (payer) perspective, and were based on patient-reported resource use data and are reported in 1999-2000 US dollars.
Results The interventions had no consistent effect on health status. Hysterectomy rates were lower for women in the interview group (38%) (adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.38-0.96) than in the control group (48%) and women who received the information alone (48%) (adjusted OR, 0.52; 95% CI, 0.33-0.82). The interview group had lower mean costs ($1566) than the control group ($2751) (mean difference, $1184; 95% CI, $684-$2110) and the information group $2026 (mean difference, $461; 95% CI, $236-$696).
Conclusions Neither intervention had an effect on health status. Providing women with information alone did not affect treatment choices; however, the addition of an interview to clarify values and elicit preferences had a significant effect on women's management and resulted in reduced costs.
Author Affiliations: Health Economics Research Group, Brunel University, Uxbridge, England (Mr Kennedy); Centre for Health Economics, University of York, York, England (Dr Sculpher); Picker Institute Europe, Oxford, England (Dr Coulter); Weston General Hospital, Weston-super-Mare, England (Dr Dwyer); John Radcliffe Hospital, Oxford, England (Dr Rees and Ms Naish); Department of Epidemiology and Public Health, University of Leicester, Leicester, England (Dr Abrams); Princess Margaret Rose Hospital, Swindon, England (Ms Horsley); St Michael's Hospital, Bristol, England (Ms Cowley and Dr Stirrat); Taunton and Somerset Hospital, Taunton, England (Ms Kidson); and St Paul's Hospital, Cheltenham, England (Ms Kirwin).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation
Stacey et al.
CA Cancer J Clin 2008;58:293-304.
ABSTRACT
| FULL TEXT
Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial
Krones et al.
Ann Fam Med 2008;6:218-227.
ABSTRACT
| FULL TEXT
Coaching to support patients in making decisions
O'Connor et al.
BMJ 2008;336:228-229.
FULL TEXT
Can Computerized Decision Support Help Patients Make Complex Treatment Decisions? A Randomized Controlled Trial of an Individualized Menopause Decision Aid
Col et al.
Med Decis Making 2007;27:585-598.
ABSTRACT
Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis
O'Connor et al.
Med Decis Making 2007;27:554-574.
ABSTRACT
Effectiveness of a Computerized Decision Aid in Primary Care on Decision Making and Quality of Life in Menorrhagia: Results of the MENTIP Randomized Controlled Trial
Protheroe et al.
Med Decis Making 2007;27:575-584.
ABSTRACT
Effectiveness of strategies for informing, educating, and involving patients
Coulter and Ellins
BMJ 2007;335:24-27.
FULL TEXT
Value of Information on Preference Heterogeneity and Individualized Care
Basu and Meltzer
Med Decis Making 2007;27:112-127.
ABSTRACT
Abnormal Uterine Bleeding: A Management Algorithm
Ely et al.
J Am Board Fam Med 2006;19:590-602.
ABSTRACT
| FULL TEXT
Developing a quality criteria framework for patient decision aids: online international Delphi consensus process
Elwyn et al.
BMJ 2006;333:417.
ABSTRACT
| FULL TEXT
A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia
You et al.
Hum Reprod 2006;21:1878-1883.
ABSTRACT
| FULL TEXT
Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making
Woolf et al.
ANN INTERN MED 2005;143:293-300.
ABSTRACT
| FULL TEXT
Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study
Clarke et al.
Qual Saf Health Care 2005;14:41-47.
ABSTRACT
| FULL TEXT
Decision aids in clinical practice
Cranney
BMJ 2004;329:39-40.
FULL TEXT
Communicating Evidence for Participatory Decision Making
Epstein et al.
JAMA 2004;291:2359-2366.
ABSTRACT
| FULL TEXT
A randomized comparison of alternative methods of information provision on the acceptability of elective single embryo transfer
Murray et al.
Hum Reprod 2004;19:911-916.
ABSTRACT
| FULL TEXT
Effect of Hysterectomy vs Medical Treatment on Health-Related Quality of Life and Sexual Functioning: The Medicine or Surgery (Ms) Randomized Trial
Kuppermann et al.
JAMA 2004;291:1447-1455.
ABSTRACT
| FULL TEXT
Diagnostic and Treatment Decisions in US Healthcare
Kaplan et al.
J Health Psychol 2004;9:29-40.
ABSTRACT
Treatments for heavy menstrual bleeding
Lethaby and Farquhar
BMJ 2003;327:1243-1244.
FULL TEXT
|
