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Randomized Controlled Trial
. 2019 Jan 1;48(1):67-74.
doi: 10.1093/ageing/afy149.

Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail

Andrea J Loizeau  1   2   3 , Nathan Theill  1   2   4 , Simon M Cohen  3 , Stefanie Eicher  1   2 , Susan L Mitchell  3   5 , Silvio Meier  2   6 , Michelle McDowell  7 , Mike Martin  1   2   6 , Florian Riese  1   4
Affiliations
Randomized Controlled Trial

Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail

Andrea J Loizeau et al. Age Ageing. .

Abstract

Background: fact Boxes are decision support tools that can inform about treatment effects.

Objectives: to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.

Design: randomized controlled trial.

Setting: Swiss-German region of Switzerland.

Subjects: two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118).

Intervention: two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month).

Methods: participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments.

Results: participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = -8.35, 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration (b = -6.02, 95% CI, -9.84, -2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration.

Conclusions: fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers.

Trial registration: FORSbase (12091).

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References

    1. World Health Organization The epidemiology and impact of dementia: current state and future trends. http://www.who.int/mental_health/neurology/dementia/dementia_thematicbri... AccessedApril 26, 2018.
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    1. van der Steen JT, Mehr DR, Kruse RL et al. . Predictors of mortality for lower respiratory infections in nursing home residents with dementia were validated transnationally. J Clin Epidemiol 2006; 59: 970–9. - PubMed
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    1. Givens JL, Jones RN, Shaffer ML, Kiely DK, Mitchell SL. Survival and comfort after treatment of pneumonia in advanced dementia. Arch Intern Med 2010; 170: 1102–7. - PMC - PubMed

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