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Development and Evaluation of Sleep Disorder Decision Aids for Veterans With Mild Traumatic Brain Injury
Adam R Kinney1, Lisa A Brenner, Morgan Nance
1Author Affiliations: Department of Veteran Affairs, Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado (Drs Kinney, Brenner, Nance, Cobb, Forster, and Bahraini); Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Drs Kinney, Nance, and Forster); Departments of Physical Medicine and Rehabilitation Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Brenner); Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans, Affairs, Durham, North Carolina (Dr Ulmer); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Dr Ulmer); Chief of Staff Office, James A. Haley Veterans Hospital, Department of Neurosurgery, University of South Florida, Tampa, Florida (Dr Nakase-Richardson); David Geffen School of Medicine at UCLA, Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Fung); and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Bahraini).
Novel decision aids for Veterans with mild traumatic brain injury (mTBI) and sleep disorders are easy to use and feasible for implementation. Feedback suggests design improvements for better integration into routine care and Veteran-centered decision-making.
Area of Science:
- Medical Informatics
- Clinical Decision Support
- Veteran Health
Background:
- Co-occurring mild traumatic brain injury (mTBI) and sleep disorders (insomnia, obstructive sleep apnea [OSA]) present unique management challenges for Veterans.
- Shared decision-making (SDM) is crucial for aligning treatment with Veteran preferences, especially in complex cases.
- The Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC) seeks innovative tools to support SDM.
Purpose of the Study:
- To design and evaluate novel decision aid prototypes for Veterans with co-morbid mTBI and sleep disorders.
- To assess the usability, acceptability, and feasibility of these decision aids within the VHA PSC.
- To gather feedback for refining prototypes and informing future implementation strategies.
Main Methods:
- Convergent parallel mixed-methods design.
- Semi-structured interviews with clinicians (n=7) and Veterans (n=5).
- Validated instruments: System Usability Scale and Ottawa Decision Aid Acceptability Scale.
Main Results:
- Decision aid prototypes were rated as easy to use, accessible, and effective for comparing treatments.
- Participants found the aids acceptable, providing essential information and facilitating SDM.
- Recommendations included design simplification, content refinement, and adjustments for implementation timelines.
Conclusions:
- The developed decision aids are user-friendly, acceptable, and feasible for managing sleep disorders in Veterans with mTBI.
- Iterative design improvements based on clinician and Veteran feedback are essential for optimal integration into routine VHA care.
- These findings support the implementation of decision aids to enhance Veteran-centered care and improve outcomes for co-morbid conditions.
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