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Randomized Controlled Trial
. 2010 May 26;12(2):e15.
doi: 10.2196/jmir.1307.

Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid

Natalie Joseph-Williams  1 , Rhodri Evans, Adrian Edwards, Robert G Newcombe, Patricia Wright, Richard Grol, Glyn Elwyn
Affiliations
Randomized Controlled Trial

Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid

Natalie Joseph-Williams et al. J Med Internet Res. .

Abstract

Background: Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures.

Objective: To examine men's use of an online decision aid for prostate cancer screening using website transaction log files (web-logs), and to examine associations between usage and components of informed decision making.

Methods: We conducted an observational web-log analysis of users of an online decision aid, Prosdex. Men between 50 and 75 years of age were recruited for an associated RCT from 26 general practices across South Wales, United Kingdom. Men allocated to one arm of the RCT were included in the current study. Time and usage data were derived from website log files. Components of informed decision making were measured by an online questionnaire.

Results: Available for analysis were 82 web-logs. Overall, there was large variation in the use of Prosdex. The mean total time spent on the site was 20 minutes. The mean number of pages accessed was 32 (SD 21) out of a possible 60 pages. Significant associations were found between increased usage and increased knowledge (Spearman rank correlation [rho] = 0.69, P < .01), between increased usage and less favorable attitude towards PSA testing (rho = -0.52, P < .01), and between increased usage and reduced intention to undergo PSA testing (rho = -0.44, P < .01). A bimodal distribution identified two types of user: low access and high access users.

Conclusions: Increased usage of Prosdex leads to more informed decision making, the key aim of the UK Prostate Cancer Risk Management Programme. However, developers realistically have roughly 20 minutes to provide useful information that will support informed decision making when the patient uses a web-based interface. Future decision aids need to be developed with this limitation in mind. We recommend that web-log analysis should be an integral part of online decision aid development and analysis.

Trial registration: ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5pqeF89tS).

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Conflict of interest statement

None declared

Figures

Figure 1
Figure 1
A screenshot of the Prosdex main contents list
Figure 2
Figure 2
A screenshot of a page on Prosdex showing the decision stacker (right) and the navigation bar (left)
Figure 3
Figure 3
A screenshot of the decision summary in use
Figure 4
Figure 4
A diagram representing the stratum approach to developing decision aids
See this image and copyright information in PMC

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References

    1. Department of Health. Department of Health: Publications policy and guidance. 2009. [2009-07-09]. The NHS Constitution for England. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati....
    1. O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003;2 doi: 10.1002/14651858.CD001431. - DOI - PubMed
    1. Elwyn Glyn, O'Connor Annette, Stacey Dawn, Volk Robert, Edwards Adrian, Coulter Angela, Thomson Richard, Barratt Alexandra, Barry Michael, Bernstein Steven, Butow Phyllis, Clarke Aileen, Entwistle Vikki, Feldman-Stewart Deb, Holmes-Rovner Margaret, Llewellyn-Thomas Hilary, Moumjid Nora, Mulley Al, Ruland Cornelia, Sepucha Karen, Sykes Alan, Whelan Tim International Patient Decision Aids Standards (IPDAS) Collaboration. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006 Aug 26;333(7565):417. doi: 10.1136/bmj.38926.629329.AE. http://www.bmj.com/cgi/pmidlookup?view=long&pmid=16908462bmj.38926.629329.AE - DOI - PMC - PubMed
    1. Elwyn Glyn, O'Connor Annette M, Bennett Carol, Newcombe Robert G, Politi Mary, Durand Marie-Anne, Drake Elizabeth, Joseph-Williams Natalie, Khangura Sara, Saarimaki Anton, Sivell Stephanie, Stiel Mareike, Bernstein Steven J, Col Nananda, Coulter Angela, Eden Karen, Härter Martin, Rovner Margaret Holmes, Moumjid Nora, Stacey Dawn, Thomson Richard, Whelan Tim, van der Weijden Trudy, Edwards Adrian. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi) PLoS One. 2009 Mar 4;4(3):e4705. doi: 10.1371/journal.pone.0004705. http://dx.plos.org/10.1371/journal.pone.0004705 - DOI - DOI - PMC - PubMed
    1. Marteau T M, Dormandy E, Michie S. A measure of informed choice. Health Expect. 2001 Jun;4(2):99–108. doi: 10.1046/j.1369-6513.2001.00140.x.hex140 - DOI - PMC - PubMed

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