Abstract 143: Development of a Novel Electronic Preventative Cardiology Decision Aid

Abstract

Objectives: Few contemporary electronic decision aids have been designed and evaluated rigorously in the realm of preventative cardiology. Our aim was to develop and test a web-based decision aid that: 1) effectively conveys information on cardiovascular disease risk as well as therapies that modify that risk, 2) improves decisional quality, and 3) is able to be efficiently implemented. Methods: We utilized the Internal Patient Decision Aid Standards (IPDAS) collaboration development process as a framework for the creation of our patient decision aid (PtDA). We conducted a literature review and convened a focus group of experts to identify risk prediction models and interventions to be included in our PtDA. Based on this, we used the AHA/ACC Pooled Cohort Risk Assessment Equations to estimate risk and included the following interventions as risk modifiers: smoking cessation, dietary modification, weight loss, exercise (grouped as healthy living options), statin therapy, and aspirin therapy. Additionally, we included evidence-based estimates on the most common side effects of aspirin and statin therapies. We then designed a web-based decision aid (located at http://demo.heartriskreport.com , username and password “innovation”). We then completed several rounds of mixed-methods alpha testing of our PtDA with patients (n=36) consisting of quantitative surveys (incorporating elements of the Control Preferences Scale and the Decisional Conflict Scale) as well as semi-structured in-person interviews. Standardized patient scenarios were utilized. Finally, we surveyed 7 national experts in the field of preventative cardiology on the accuracy and usability of our PtDA. Results: The majority (92%, 33/36) of patients wished to incorporate elements of shared decision making processes when considering their care. Patients estimated risk 20 % points different from risk determined by validated calculators prior to using the PtDA. After using the PtDA, the patients’ estimation differed by less than one point from actual risk. The majority of patients knew which healthy living (94% of patients, 34/36) and medication (86% of patients, 31/36) options were available. Similarly, most patients knew the benefits of healthy living (89%, 32/36) and medication (86%, 31/36) options. The majority of patients understood the risks of medication options (89%, 32/36). In terms of feedback from our external experts (n=7), 100% of experts felt the PtDA was useful, accurate, and comprehensible to patients. All experts felt they would utilize the PtDA with their own patients. The majority of experts felt the PtDA would be best used in an exam room with a patient (67%, 4/7) and felt that the primary physician would be the best provider to review the PtDA with a patient (86%, 6/7). Conclusions: Our PtDA is highly usable and effective in conveying information regarding cardiovascular risk and common therapies to patients.