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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).
Objective:
First, to summarize the design of novel decision aid prototypes aimed at facilitating shared decision-making for Veterans with co-morbid mild traumatic brain injury (mTBI) and sleep disorders (insomnia, obstructive sleep apnea [OSA]) in the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Second, to elicit feedback regarding usability, acceptability, and feasibility of prototypes to inform future implementation.
Setting:
Nationwide VHA PSC sites.
Participants:
Clinicians included VHA providers involved in the management of mTBI and/or sleep disorders in the VHA PSC ( n = 7). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and OSA within the past year ( n = 5).
Design:
Convergent parallel mixed methods.
Main Measures:
Semi-structured interview guides; System Usability Scale; Ottawa Decision Aid Acceptability Scale.
Results:
Participants found the decision aid prototypes easy to use, highlighting its accessibility and features enabling an easy comparison of treatments. However, participants recommended changes to simplify and improve the design. Decision aids were seen as acceptable, providing essential information for Veterans with mTBI and facilitating shared decision-making among providers, Veterans, and other decision partners (eg, spouse). Removal of non-essential content was recommended to increase acceptability. Decision aids were considered feasible to implement, though extending the decision-making process beyond the initial encounter and accounting for time constraints were recommended.
Conclusions:
Findings highlight that the decision aids are easy-to-use, feasible to implement, and capable of improving Veteran-centered management of sleep disorders among those with mTBI. Nonetheless, clinicians and Veterans offered recommendations for changes that can improve the utility of the decision aids and facilitate their seamless integration into routine care for Veterans with co-morbid mTBI and sleep disorders. Findings lay the foundation for efforts aimed at implementing the decision aids into routine care for sleep disorders in the VHA PSC, aligning care decisions with Veteran preferences and improving outcomes.
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