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A randomized controlled clinical trial of a patient decision aid for posttraumatic stress disorder
Bradley V Watts1, Paula P Schnurr, Maha Zayed
1Dr. Watts and Dr. Young-Xu are with the U.S. Department of Veterans Affairs (VA) National Center for Patient Safety, White River Junction, Vermont, and they are also with the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, where Dr. Schnurr is also affiliated (e-mail: bradley.v.watts@dartmouth.edu ). Dr. Schnurr is also with the VA National Center for PTSD, White River Junction. Dr. Zayed and Ms. Stender are with the Mental Health Service, White River Junction VA Medical Center. Dr. Llewellyn-Thomas is with the Dartmouth Institute and the Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover.
Objective:
Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment.
Methods:
The study was a randomized trial of a patient decision aid for PTSD versus treatment as usual (control group). The participants were 132 male and female veterans who presented to a single U.S. Department of Veterans Affairs hospital with a new diagnosis of PTSD. Patient centeredness was assessed by knowledge of PTSD and its treatment, level of decisional uncertainty, and ability to state a preferred treatment option. Secondary outcomes included treatments received and PTSD symptoms in the six months after study entry.
Results:
Compared with the control group (N=65), participants who reviewed the patient decision aid (N=63) had higher scores for PTSD knowledge (p=.002) and less conflict about their choice of treatment (p=.003). In addition, participants who reviewed the patient decision aid were more likely to select and receive an evidence-based treatment for PTSD (p=.04) and had superior PTSD outcomes (p=.004) compared with the control group.
Conclusions:
Use of a patient decision aid was associated with improvements in patient-centered PTSD treatment. The patient decision aid was also associated with greater use of evidence-based treatments and improvement of PTSD symptoms. This study suggests that clinics should consider using a patient decision aid for patients with PTSD.
