Decision support by telephone: randomized controlled trial in a rural community setting

Area of Science:

• Health Services Research
• Patient Support Interventions
• Telehealth

Background:

• Consultation Planning (CP) is a question-listing intervention previously delivered in-person.
• Evaluating alternative delivery methods for CP is crucial for accessibility and scalability.

Purpose of the Study:

• To assess the effectiveness, cost, and patient value of delivering Consultation Planning (CP) via telephone (Tele-CP) compared to in-person delivery.
• To determine if Tele-CP is non-inferior to in-person CP in enhancing decision self-efficacy for rural breast cancer patients.

Main Methods:

• A randomized controlled trial comparing Tele-CP and In-Person CP among rural women with breast cancer (2007-2010).
• Decision self-efficacy was the primary outcome, measured on a 0-4 scale, with a non-inferiority margin of 15%.
• Psychosocial and economic outcomes, including intervention costs and willingness-to-pay, were also analyzed.

Main Results:

• Tele-CP recipients reported similar mean decision self-efficacy ratings (3.53) compared to in-person CP recipients (3.44).
• Tele-CP was non-inferior to in-person CP, with the null hypothesis of greater than 0.52 inferiority rejected (95% CI: -0.44 to 0.13, p=0.006).
• Intervention costs were lower for Tele-CP ($48) versus in-person CP ($78), with comparable patient willingness-to-pay.

Conclusions:

• Telephone delivery of Consultation Planning is a non-inferior alternative to in-person delivery.
• Tele-CP offers comparable quality, cost-effectiveness, and patient value.
• Healthcare organizations should consider adopting telephone delivery for CP and similar interventions.