The need for patient decision aids in acute care settings.

Objective: To test the effect of a new decision support tool for acute appendicitis and assess its efficacy and acceptability. Background: Mounting evidence from randomized controlled trials have shown that antibiotics can be a safe and effective treatment for appendicitis. Patients and surgeons must work together to choose the optimal treatment approach for each patient based on their own preferences and values. We developed a decision support tool to facilitate shared decision-making for appendicitis and its effect on decisional outcomes remains unknown. Methods: We conducted an online randomized field test in at-risk individuals comparing the decision support tool to a standard infographic. Individuals were randomized 3:1 to view the decision support tool or infographic. The primary outcome was the total decisional conflict scale (DCS) score measured before and after exposure to the decision support tool. Secondary outcomes included between-group DCS scores, and between-group comparisons of the acceptability. Results: One hundred eighty individuals were included in the study. Total DCS scores decreased significantly after viewing the decision support tool (59 [95% confidence interval (CI): 55–63] to 15 [95% CI: 12–17], P < 0.001) representing movement from a state of high to low decisional conflict. Individuals exposed to the decision support tool reported higher acceptability ratings (3.7 [95% CI: 3.6–3.8] vs 3.3 [95% CI: 3.2–3.5] out of 4) and demonstrated increased willingness to consider both treatment options. Conclusions: These data support the further use and testing of this novel decision support tool in patients with acute appendicitis.

Randomized Pilot Test of a Decision Support Tool for Acute Appendicitis

Background: Multiple randomized controlled trials have shown that it is safe and effective to treat appendicitis with antibiotics or surgery. There are no tools available to assist surgeons and their patients in choosing the optimal treatment for each individual patient. Here we describe the development of a new decisions support tool (DST) for acute appendicitis and place it in the context of international guidelines for decision aid development. 

Methods: The stakeholder engagement and development process for the DST is described. The DST and its development process are placed in the context of the International Patient Decision Aid Standards (IPDAS) and the DEVELOPTOOLS checklist for a user-centered design process. 

Results: A diverse group of over 60 stakeholders were involved in the needs-assessment, development, and evaluation of the DST. The development process met 11/11 of the scored items on the DEVELOPTOOLS checklist. Of the 34 applicable IPDAS items, the current version of the DST meets 31 of them including 6/6 qualifying criteria, 6/6 certification criteria, and 18/22 quality criteria. 

Conclusions: The novel appendicitis DST was developed with the input of multiple stakeholders. The development process and the tool itself complies with best practices recommended by the IPDAS.

https://medrxiv.org/content/10.1101/2021.11.08.21266077v1.full.pdf

Jonathan E. Kohler

Papers

Development of a Decision Support Tool for Acute Appendicitis