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Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes

BACKGROUND: Despite widespread use, there are few studies evaluating the consumer Choosing Wisely questions. METHODS: We evaluated the impact of the Choosing Wisely questions on consumers’ decision-making outcomes. Adults living in Australia were presented with a hypothetical low-value care scenario...

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Autores principales: Muscat, Danielle Marie, Thompson, Rachel, Cvejic, Erin, Smith, Jenna, Chang, Edward Hoi-fan, Tracy, Marguerite, Zadro, Joshua, Lindner, Robyn, McCaffery, Kirsten J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422858/
https://www.ncbi.nlm.nih.gov/pubmed/37403779
http://dx.doi.org/10.1177/0272989X231184461
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author Muscat, Danielle Marie
Thompson, Rachel
Cvejic, Erin
Smith, Jenna
Chang, Edward Hoi-fan
Tracy, Marguerite
Zadro, Joshua
Lindner, Robyn
McCaffery, Kirsten J.
author_facet Muscat, Danielle Marie
Thompson, Rachel
Cvejic, Erin
Smith, Jenna
Chang, Edward Hoi-fan
Tracy, Marguerite
Zadro, Joshua
Lindner, Robyn
McCaffery, Kirsten J.
author_sort Muscat, Danielle Marie
collection PubMed
description BACKGROUND: Despite widespread use, there are few studies evaluating the consumer Choosing Wisely questions. METHODS: We evaluated the impact of the Choosing Wisely questions on consumers’ decision-making outcomes. Adults living in Australia were presented with a hypothetical low-value care scenario. Using a 2×2×2 between-subjects factorial design, they were randomized to either the Choosing Wisely questions (“Questions”), a shared decision-making (SDM) preparation video (“Video”), both interventions, or control (no intervention). Primary outcomes were 1) self-efficacy to ask questions and be involved in decision-making and 2) intention to engage in SDM. RESULTS: A total of 1,439 participants (45.6% with “inadequate” health literacy) were eligible and included in the analysis. Intention to engage in SDM was higher in people randomized to the Video (mean difference [MD] = 0.24 [scale 0–6], 95% confidence interval [CI]: 0.14, 0.35), Questions (MD = 0.12, 95% CI: 0.01, 0.22), and both interventions (MD = 0.33, 95% CI: 0.23–0.44, P < 0.001, d = 0.28) compared with control. Combining interventions had a greater impact than presenting the Questions alone (MD = 0.22, 95% CI: 0.11, 0.32; P < 0.001). Those who received the Video or both interventions reported lower intention to follow the low-value treatment plan without further questioning (all P < 0.05) and more positive attitudes toward SDM (all P < 0.05) compared with control. Intervention acceptability was high in all study arms (>80%), but proactive access was low (1.7%–20.8%). Compared with control, participants who received one or both interventions asked more questions that mapped to the Choosing Wisely questions (all P < .001). There were no main effects of either intervention on self-efficacy or knowledge. CONCLUSIONS: The Choosing Wisely questions and a video to promote SDM may improve intention to engage in SDM and support patients in identifying questions that align with the Choosing Wisely campaign (with some additional benefits of the video intervention). TRIAL REGISTRATION: ANZCTR376477 HIGHLIGHTS: We conducted a randomized controlled trial online with adults living in Australia to test the effectiveness of the consumer Choosing Wisely questions and a shared decision-making (SDM) preparation video. Both interventions improved intention to engage in SDM and supported participants to identify questions that align with the Choosing Wisely campaign. There were some additional benefits of the Video intervention in reducing willingness to accept low-value treatment for low-back pain without asking questions; however, neither intervention changed participants’ self-efficacy to ask questions and be involved in decision-making nor affected perceptions of preparedness to engage in SDM or knowledge of rights to be involved in health care decision-making. The simple, low-cost nature of the interventions may make them appropriate for implementation within a suite of approaches to address low-value care at a population level.
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spelling pubmed-104228582023-08-13 Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes Muscat, Danielle Marie Thompson, Rachel Cvejic, Erin Smith, Jenna Chang, Edward Hoi-fan Tracy, Marguerite Zadro, Joshua Lindner, Robyn McCaffery, Kirsten J. Med Decis Making Original Research Articles BACKGROUND: Despite widespread use, there are few studies evaluating the consumer Choosing Wisely questions. METHODS: We evaluated the impact of the Choosing Wisely questions on consumers’ decision-making outcomes. Adults living in Australia were presented with a hypothetical low-value care scenario. Using a 2×2×2 between-subjects factorial design, they were randomized to either the Choosing Wisely questions (“Questions”), a shared decision-making (SDM) preparation video (“Video”), both interventions, or control (no intervention). Primary outcomes were 1) self-efficacy to ask questions and be involved in decision-making and 2) intention to engage in SDM. RESULTS: A total of 1,439 participants (45.6% with “inadequate” health literacy) were eligible and included in the analysis. Intention to engage in SDM was higher in people randomized to the Video (mean difference [MD] = 0.24 [scale 0–6], 95% confidence interval [CI]: 0.14, 0.35), Questions (MD = 0.12, 95% CI: 0.01, 0.22), and both interventions (MD = 0.33, 95% CI: 0.23–0.44, P < 0.001, d = 0.28) compared with control. Combining interventions had a greater impact than presenting the Questions alone (MD = 0.22, 95% CI: 0.11, 0.32; P < 0.001). Those who received the Video or both interventions reported lower intention to follow the low-value treatment plan without further questioning (all P < 0.05) and more positive attitudes toward SDM (all P < 0.05) compared with control. Intervention acceptability was high in all study arms (>80%), but proactive access was low (1.7%–20.8%). Compared with control, participants who received one or both interventions asked more questions that mapped to the Choosing Wisely questions (all P < .001). There were no main effects of either intervention on self-efficacy or knowledge. CONCLUSIONS: The Choosing Wisely questions and a video to promote SDM may improve intention to engage in SDM and support patients in identifying questions that align with the Choosing Wisely campaign (with some additional benefits of the video intervention). TRIAL REGISTRATION: ANZCTR376477 HIGHLIGHTS: We conducted a randomized controlled trial online with adults living in Australia to test the effectiveness of the consumer Choosing Wisely questions and a shared decision-making (SDM) preparation video. Both interventions improved intention to engage in SDM and supported participants to identify questions that align with the Choosing Wisely campaign. There were some additional benefits of the Video intervention in reducing willingness to accept low-value treatment for low-back pain without asking questions; however, neither intervention changed participants’ self-efficacy to ask questions and be involved in decision-making nor affected perceptions of preparedness to engage in SDM or knowledge of rights to be involved in health care decision-making. The simple, low-cost nature of the interventions may make them appropriate for implementation within a suite of approaches to address low-value care at a population level. SAGE Publications 2023-07-05 2023-08 /pmc/articles/PMC10422858/ /pubmed/37403779 http://dx.doi.org/10.1177/0272989X231184461 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Articles
Muscat, Danielle Marie
Thompson, Rachel
Cvejic, Erin
Smith, Jenna
Chang, Edward Hoi-fan
Tracy, Marguerite
Zadro, Joshua
Lindner, Robyn
McCaffery, Kirsten J.
Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title_full Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title_fullStr Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title_full_unstemmed Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title_short Randomized Trial of the Choosing Wisely Consumer Questions and a Shared Decision-Making Video Intervention on Decision-Making Outcomes
title_sort randomized trial of the choosing wisely consumer questions and a shared decision-making video intervention on decision-making outcomes
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10422858/
https://www.ncbi.nlm.nih.gov/pubmed/37403779
http://dx.doi.org/10.1177/0272989X231184461
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