Where, How, and How Much? A Multicenter Cohort Study of the Relationship Across Lupus Decision-Aid Modality, Place of Administration, Interruption and Viewing Completeness, and Patient-Reported Outcomes.

Abstract

We assessed whether shared decision-making (SDM) and patient acceptability, feasibility, and overall satisfaction with a computerized patient decision aid (PtDA) for patients with systemic lupus erythematosus (SLE) differs by PtDA setting, modality, and the viewing experience. Patients with SLE were invited to view a self-administered computerized SLE PtDA during regular clinic visits at 15 rheumatology clinics in an implementation trial. Patients completed a survey that included SDM measures including the decision conflict scale (DCS), Preparation for Decision Making (PDM) scale, and CollaboRATE scale, and we measured perceived patient acceptability, feasibility, and satisfaction. Patients viewed the SLE PtDA in two settings/places, in clinic or at home (telemedicine visits), using one of three modalities, a touchpad computer, smart phone, or computer (desktop or laptop computer). We also assessed the effects of interruptions while viewing the PtDA and incomplete viewings. We had a cohort of 813 patients with SLE (43% of 1,895 total) who completed the PtDA modality and setting questions, which were added midway after the COVID-19 pandemic started. In a multivariable-adjusted logistic regression analysis, the setting or modality of viewing the SLE PtDA were not associated with SDM or patient outcomes except the association of place of viewing with feasibility. We noted important significant associations of interruption while viewing the SLE PtDA with lower feasibility, acceptability, and PDM and DCS scores and incomplete viewing of the SLE PtDA with worse PDM and DCS scores. The SLE PtDA was effective regardless of setting and modality of delivery. Uninterrupted and complete viewing of the SLE PtDA is desirable for better SDM and higher acceptability.