A tale of two studies: the importance of setting, subjects and context in two randomized, controlled trials of a web-based decision support for perimenopausal and postmenopausal health decisions

Patient Educ Couns. 2007 May;66(2):211-22. doi: 10.1016/j.pec.2006.12.004. Epub 2007 Feb 20.

Abstract

Objective: Knowledge relevant to women's peri- and postmenopausal health decisions has been evolving rapidly. Web-based decision supports can be rapidly updated and have the potential to improve the quality of patients' decisions. We developed and tested a web-based decision support for peri- and postmenopausal health decisionmaking.

Methods: We recruited 409 women aged 45-75 for one randomized, controlled trial and 54 women with an upcoming clinic appointment for a subsequent trial. Women were randomized to use the web-based decision support versus a printed brochure (first trial) and usual care (second trial). Outcomes were changes in decisional satisfaction, decisional conflict, and knowledge, both within each trial and compared across the trials.

Results: Intervention subjects had greater increases in decisional satisfaction in the second trial and knowledge in both trials. A high dropout rate among women randomized to the website in the first trial effectively negated benefits in that trial, but not in the second.

Conclusions: The utility of this web-based decision support in two trials depended on a number of factors that appear related to the urgency of making a decision.

Practice implications: Decision aids should be targeted to patients actively trying to make a decision.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Computer-Assisted Instruction / methods
  • Computer-Assisted Instruction / standards
  • Conflict, Psychological
  • Decision Support Techniques*
  • Estrogen Replacement Therapy / adverse effects
  • Estrogen Replacement Therapy / psychology
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internet / standards*
  • Middle Aged
  • Pamphlets
  • Patient Education as Topic / methods*
  • Patient Education as Topic / standards
  • Patient Satisfaction*
  • Perimenopause / drug effects
  • Perimenopause / psychology*
  • Postmenopause / drug effects
  • Postmenopause / psychology*
  • Risk Assessment
  • Surveys and Questionnaires
  • Teaching Materials / standards
  • Uncertainty
  • United States
  • Women / education
  • Women / psychology