Evaluating a Web-Based Decision Aid for Preventative Cardiology

Rathnam Venkat, Sarah MurrayMentor: Dr. Emil deGoma

Team-Mentor: Dr. Emil deGoma, M.D.-Dr. Sri Adusumalli, M.D., Cardiology Fellow-Polina Ferd, Research Coordinator-Rathnam Venkat, SUMR Scholar, Research Assistant-Sarah Murray, PURM Scholar, Research Assistant

Background-A web-based decision aid was created to give patients more of a role in decision-making regarding interventions to reduce their risk of heart attack or stroke-The decision aid promotes the idea of “shared decision making” between the doctor and patient-Gives 10 year baseline risk for having a cardiovascular event-Informs patients about interventions, explains the benefits and potential side effects of certain therapies

Project Overview-Conducted interviews with patients in the Cardiology clinic-Analyzed patient feedback to create 3 iterations of the decision aid-Qualitatively coded interview transcripts to see frequency of themes-Drafted a review article highlighting the nature of decision aids in preventative cardiology

Significance-A web-based decision aid for preventative cardiology needed to be developed due to the lack of tools to promote shared decision making in the field-The most prominent decision aid in preventative cardiology, the Statin Choice Decision Aid, developed by the Mayo Clinic, only shows the benefits and drawbacks of taking statins to lower risk-The second most prominent decision aid, the Heart-to-Heart decision aid, developed by the University of North Carolina, is very elementary in nature and does not cater to patient needs

Aims-To edit the preliminary version of a web-based decision aid for preventative cardiology based on patient suggestions-To quantitatively and qualitatively analyze the degree to which patients liked various aspects of the decision aid-To explore the nature of current decision aids in preventative cardiology through a review

Focus Groups-Before we joined the project, Dr. deGoma and Dr. Adusumalli conducted 4 focus groups with physicians to determine what providers value and find effective in a decision aid-A total of 40 physicians took part in these focus groups

Patient InterviewsPatient interviews helped determine what edits should be made to the decision aid tool.

Prototype → First Version → First Edit → Second Version → Second Edit → Most Recent Version

Patient Interviews-Consented the patient to inform him or her of patient rights, confidentiality, and the purpose of the study-Recorded the interview after consent in order to create a transcript for later analysis-Followed an interview script to give the patient background information on general risk of having a heart attack or stroke due to plaque buildup in the arteries-Walked the patient through a scenario regarding a fake patient named Bob-Took notes on the patient’s feedback in order to edit the decision aid in real time-Instructed the patient to fill out a survey on RedCap

Statistical Analysis-Calculated the percentage of subjects that a particular demographic represented-Calculated the difference between the pre-decision aid patient estimate and the actual risk as well as the difference between the post-decision aid patient estimate and the actual value. -Found mean, standard deviation, median, and interquartile range of qualitative answers

Scaling-Sliding bar answers were scaled from 1-10-Calculated the mean, standard deviation, median, interquartile range and percent favorability for which we defined a “favorable” response to be one with a numerical value of 6 or higher.

Qualitative Coding-Coded results based on themes, went through and coded 5 transcripts based on original themes, then discussed and edited to come up with final list of themes-Coded all transcripts based on final list of themes, analyzed frequency of each theme

Final List of Themes1. Decision aid is simple to use

-easy to understand -easy to input information

2. would use independently (alone)3. would use in preparation of a doctor’s visit4. would use guided by a physician 5. Did not like/understand the randomized graphic 6. Liked the (all) graphic(s)7. liked/understood the side effects page8. would like access to report/information from DA9. wants to combine interventions

Most Recent Version

demo.heartriskreport.com

Demographics

How Patients Wish to Make Decisions

Test of Understanding Risk

Difference 1[Pre-DA Estimate - Actual]

Difference 2 [Post-DA Estimate] - [Actual]

Mean 19.5 -0.22

Standard Deviation 23.52 2.34

Median 23 0

Test of Usability“Would you have found this decision aid useful when making

decisions about cardiovascular risk for yourself?” (N=36)

Measuring Favorability

Findings: Theme-Based Coding (n=22)Theme Frequency Percent

Decision Aid is simple to use 14 63%

Liked graphics 13 59%

Would use independently 11 50%

Liked / understood side effects page 7 32%

Use in preparation of visit 7 32%

Did not like/understand randomized graphic 3 14%

Use guided by physician 3 14%

Would like access to report/info 2 9%

Wants to combine interventions 0 0%

Rathnam’s Role in the Project-Conducted patient interviews and consented the patients-Wrote the review essay on the Statin Choice Decision Aid which included the following sections: Introduction, Components, Development, Data Examining Decision Aid’s Use, and References-Created a table of current decision aids in preventative cardiology-Table included1. Statin Choice Decision Aid (Montori 2007)2. Health Decision: Cardiovascular Risk Decision Support Tool (2015)3. Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke? (2014)4. Choosing Medicines for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and

DRIs(2011)

Rathnam’s Role in the Project-Met with Dr. deGoma to discuss patient feedback and drafted edits to the decision aid in word and picture format to be sent to the programmer-Worked with Sarah on the quantitative and statistical analysis-Coded 11 transcripts (22 total)

Sarah’s Role in the Project-Conducted patient interviews and consented the patients-Wrote the review essay on the Heart-to-Heart Decision Aid which included the following sections: Introduction, Components, Development, Data Examining Decision Aid’s Use, and References-Created a table of current decision aids in preventative cardiology-Table included1. Heart to Heart (UNC 2003)2. High Blood Pressure: Should I Take Medicine (2009)3. Statins: Should I take them? (2000)4. Statins for heart disease risk: yes or no? (2015)

Sarah’s Role in the Project-Met with Dr. deGoma to discuss patient feedback and drafted edits to the decision aid in word and picture format to be sent to the programmer-Worked with Rathnam on the quantitative and statistical analysis-Coded 11 transcripts (22 total)-Reconciled gift cards given to study participants

Lessons Learned-How to consent a patient-Information on the causes of heart attack and stroke as well as different treatment options-How to conduct a statistical analysis of data-How to conduct clinical research and interact with patients-The nature of shared decision making and the potential of decision aids in preventative cardiology-Methods to interpret qualitative data (Meeting with Dr. Judy Shea)-Biology lecture on lipids (Lecture by Dr. Soffer)

Thanks!

Question and Answer