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Implementation of a Guideline-Based Preference Elicitation Tool to Enhance Shared Decision-Making in Supervised
Laura H M Marcellis1,2, Steffie Spruijt2, Katrien M Rutgers3
1Radboud university medical center, IQ Health science department, Nijmegen, the Netherlands.
Importance:
Shared decision-making is not yet common practice in physical therapy, emphasizing the need for effective decision aids. A preference elicitation tool (PE-tool) was designed to complement supervised exercise therapy (SET) in intermittent claudication treatment.
Objective:
Primarily, to assess the impact of implementing the PE-tool on patients' functional walking distance (FWD), maximal walking distance (MWD) and health-related quality of life (HRQoL) after 3 and 6 months. Secondarily, to assess the tool's impact on shared decision-making and person-centeredness.
Design:
Nationwide pragmatic cluster randomized trial.
Setting:
Primary care physical therapy practices in the Netherlands.
Participants:
Primary care physical therapists and patients with intermittent claudication receiving SET.
Exposure(S):
Therapists assigned to the intervention group had access to the PE-tool to complement SET, whereas therapists in the control group delivered SET.
Main Outcome(S) And Measure(S):
Group differences in FWD, MWD, and HRQoL at 3- and 6-month follow-ups were assessed using routinely collected clinical data. Audio-recorded consultations between therapists and patients in the intervention (n = 72) and control group (n = 74) were assessed using the OPTION-5 instrument to assess shared decision-making. Participating patients completed a questionnaire afterwards to assess person-centeredness.
Results:
Intention-to-treat analyses indicated no statistically significant differences between intervention (n = 1199 patients) and control (n = 915 patients) groups at both follow-ups for FWD and MWD. For HRQoL, a statistically significant difference favoring the control group was found at 3-month follow-up (MD = -0.3 points), but not at 6-month (MD = -0.3 points). Statistically significant effects favoring the intervention group were found for shared decision-making (MD = +39.0 points) and person-centeredness (MD = +2.0 points).
Conclusions:
Use of the PE-tool in intermittent claudication treatment did not improve patient-level outcomes compared to SET alone, but positively impacted levels of shared decision-making and person-centeredness.
Relevance:
Although achieving health improvements through decision aids remains complex, the novel tool could support therapists in adopting a more collaborative and person-centered approach.
