Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care

OBJECTIVE: To determine whether a decision aid on benign prostatic hypertrophy influences decision making, health outcomes, and resource use. DESIGN: Randomised controlled trial. SETTING: 33 general practices in the United Kingdom. PARTICIPANTS: 112 men with benign prostatic hypertrophy. INTERVENTION: Patients' decision aid consisting of an interactive multimedia programme with booklet and printed summary. OUTCOME MEASURES: Patients' and general practitioners' perceptions of who made the decision, decisional conflict scores, treatment choice and prostatectomy rate, American Urological Association symptom scale, costs, anxiety, utility, and general health status. RESULTS: Both patients and general practitioners found the decision aid acceptable. A higher proportion of patients (32% v 4%; mean difference 28%, 95% confidence interval 14% to 41%) and their general practitioners (46% v 25%; 21%, 3% to 40%) perceived that treatment decisions had been made mainly or only by patients in the intervention group compared with the control group. Patients in the intervention group had significantly lower decisional conflict scores than those in the control group at three months (2.3 v 2.6; −0.3, −0.5 to −0.1, P<0.01) and this was maintained at nine months. No differences were found between the groups for anxiety, general health status, prostatic symptoms, utility, or costs (excluding costs associated with the video disc equipment). CONCLUSIONS: The decision aid reduced decisional conflict in men with benign prostatic hypertrophy, and the patients played a more active part in decision making. Such programmes could be delivered cheaply by the internet, and there are good arguments for coordinated investment in them, particularly for conditions in which patient utilities are important.

研究目标：明确针对良性前列腺增生（benign prostatic hypertrophy）的决策辅助工具是否会对决策制定、健康结局及医疗资源利用产生影响。
研究设计：随机对照试验（randomised controlled trial）。
研究场景：英国境内33家全科诊疗机构。
研究对象：112名良性前列腺增生患者。
干预措施：为患者提供由交互式多媒体程序、手册及印刷版摘要组成的决策辅助工具。
结局指标：患者与全科医师对决策主体的认知、决策冲突评分、治疗选择及前列腺切除术比例、美国泌尿外科学会症状量表（American Urological Association symptom scale）评分、医疗成本、焦虑水平、效用值及一般健康状况。
研究结果：患者与全科医师均认为该决策辅助工具具备可接受性。相较于对照组，干预组中更高比例的患者（32% vs 4%；平均差值28%，95%置信区间14%至41%）及其全科医师（46% vs 25%；平均差值21%，95%置信区间3%至40%）认为治疗决策主要或仅由患者做出。干预组患者在3个月时的决策冲突评分显著低于对照组（2.3 vs 2.6；差值-0.3，95%置信区间-0.5至-0.1，P<0.01），该差异在9个月时仍持续存在。两组在焦虑水平、一般健康状况、前列腺症状、效用值及医疗成本（不含视频光盘设备相关成本）方面均未观察到显著差异。
研究结论：该决策辅助工具可降低良性前列腺增生患者的决策冲突，并使患者在决策过程中发挥更积极的作用。此类程序可通过互联网以低成本开展部署，且存在充分依据支持对其进行协同投资，尤其适用于患者效用值为核心考量因素的疾病场景。