Putting the Patient in Patient-Centred Care: Pilot Testing an Updated Patient Decision Aid for Plaque Psoriasis

Patient decision aids (PDAs) are tools to engage patients in shared decision making by informing them of treatment options, associated risks, and benefits, as well as eliciting their preferences and values relevant to treatment. A PDA for psoriasis grounded in evidence-based clinical practice guidelines ¹ was shown to reduce decisional conflict and improve patient knowledge. ² This was recently updated to include newly approved treatments and was transformed into an online format.

Our objective was to assess the effectiveness of this updated psoriasis PDA. Participants were recruited through a dermatology practice in Windsor, Ontario, Canada. All provided written consent, completed a pretest survey, used the PDA, and attended a consultation with a dermatologist. They then completed 2 follow-up surveys (1 week [n = 11] and 4 weeks [n = 10]). The surveys assessed knowledge of psoriasis, treatments, decisional conflict, acceptability of the PDA, preparation for decision making, and decisional regret.

Participants were prepared to decide immediately after viewing the PDA (mean = 3.38, SD = 1.03). At follow-up, patients experienced very little decisional regret (mean = 15.0, SD = 12.25). A nonsignificant increase in total decisional conflict from pre- to posttest surveys was observed (Table 1), but these levels decreased by the 4-week follow-up (Table 2). Furthermore, there was a significant increase in knowledge from pre to post (P = .03), which was only marginally significant (P = .06) at the follow-up.

OPEN IN VIEWER

Table 1.

Results of t Tests and Descriptive Statistics for Decisional Conflict and Knowledge (n = 11).

	Time				95% CI for Mean Difference	t(10)
	Pretest		Posttest (1-Week Follow-up)
	Mean	SD	Mean	SD
Knowledge scale total	9.00	3.26	11.00	3.22	−3.73 to −0.27	2.58 a
Decisional conflict—total score	26.28	17.52	29.55	13.83	−10.59 to 4.06	0.99
Uncertainty	28.79	26.45	31.82	19.66	−17.25 to 11.19	0.48
Informed	40.15	21.67	38.64	13.58	−10.18 to 13.21	0.29
Values	25.76	19.53	28.79	14.12	−13.73 to 7.67	0.63
Support	18.18	15.73	24.24	15.57	−12.73 to 0.61	2.03
Effectiveness	20.45	20.75	25.57	18.43	−16.03 to 5.81	1.04

a

P = .03.

OPEN IN VIEWER

Table 2.

Results of t Tests and Descriptive Statistics for Decisional Conflict and Knowledge Scale (n = 10).

	Time				95% CI for Mean Difference	t(9)
	Pretest		Posttest (4-Week Follow-up)
	Mean	SD	Mean	SD
Knowledge scale total	10.10	2.96	11.20	2.35	−2.24 to 0.04	2.18 a
Decisional conflict—total score	22.50	13.72	18.75	11.48	−1.55 to 9.05	1.60
Uncertainty	24.17	19.42	20.00	14.80	−0.90 to 9.23	1.86
Informed	32.50	18.61	20.83	14.30	−1.57 to 24.91	1.99
Values	20.83	16.32	20.00	13.15	−13.89 to 15.56	0.13
Support	19.17	14.19	16.67	13.61	−5.47 to 10.47	0.71
Effectiveness	17.50	13.11	16.88	12.52	−4.73 to 5.98	0.26

a

P = .06.

Most participants indicated that the PDA would help them decide (n = 7; 64%), made their decision easier (n = 9; 82%), and was an adequate length (n = 10; 91%) with the right amount of information (n = 10; 91%).

The PDA was successful in teaching patients new information. In an earlier study, ³ patients indicated a desire for more information; our findings suggest that we met this need. Surprisingly, the PDA did not significantly improve decisional conflict. This finding is likely due to the nature of our sample. First, decisional conflict scores were very low across all time points, suggesting the current patients experienced very little uncertainty from the beginning of the decision-making process. Second, since all participants had a history of psoriasis treatment, they had already been through the process of choosing a treatment. It is possible that pretest decisional conflict was quite low because they felt positively toward their current or previous treatments. By providing new information and prompting reflection on ones’ values, the PDA may have led to a temporary increase in conflict that the patient would have to reconcile. Indeed, decisional conflict scores decreased nonsignificantly at the 4-week follow-up.

Overall, participants responded positively to the PDA, reporting that it was appropriate in both content and length. Furthermore, most participants indicated that it was useful in helping them decide. Limitations of this study include a small sample size and lack of a control group. Future research should incorporate a larger sample for a randomized control trial of patients who are actively seeking treatment.

The current PDA shows promise for implementation. It was successful in increasing knowledge, with patients also reporting an acceptance of the PDA, moderate preparedness, and low decisional regret. The psoriasis PDA is online and accessible without cost at http://www.informed-decisions.org.