Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail
Abstract Background fact Boxes are decision support tools that can inform about treatment effects. Objectives to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design ran...
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| Veröffentlicht in: | Age and ageing 2019-01, Vol.48 (1), p.67-74 |
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| creator | Loizeau, Andrea J Theill, Nathan Cohen, Simon M Eicher, Stefanie Mitchell, Susan L Meier, Silvio McDowell, Michelle Martin, Mike Riese, Florian |
| description | Abstract
Background
fact Boxes are decision support tools that can inform about treatment effects.
Objectives
to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.
Design
randomized controlled trial.
Setting
Swiss-German region of Switzerland.
Subjects
two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118).
Intervention
two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month).
Methods
participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments.
Results
participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration.
Conclusions
fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers.
Trial registration
FORSbase (12091). |
| doi_str_mv | 10.1093/ageing/afy149 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6322502</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ageing/afy149</oup_id><sourcerecordid>2306307738</sourcerecordid><originalsourceid>FETCH-LOGICAL-c448t-8952723e2f7c96f58996d9933afad72a0ca09a0ace165006c261274984f881a13</originalsourceid><addsrcrecordid>eNqFkkuPFCEQxztG446rR6-GxIuXdnn0AzyY6MZVk0286JnU0DDLhoYW6I3jF_JrWptZx8fFC1DUr_5VFNU0Txl9yagSZ7CzPu7OwO1Zp-41G9YNsuVSdPebDaWUt3Tk6qR5VMo1mqxn_GFzIqjgjA9y0_y4AFPJ2_SNTNb44lMkZV2WlCupKYVCsp1WY49eCMSk6ILHKNimFddY_dan6k0hLmWyRLvOKXpAz0QgV--88Rh3tZ8y1NsMPhKYbiAaO6HwbFEBXhEgGSPS7L_jNSapOYWAx5rBh8fNAweh2Cd3-2nz5eLd5_MP7eWn9x_P31y2putkbaXq-ciF5W40anC9VGqYlBICHEwjB2qAKqBgLBt6SgfDB8bHTsnOScmAidPm9UF3WbeznQzWliHoJfsZ8l4n8PpvT_RXepdu9CA47ylHgRd3Ajl9XW2pevbF2BAg2rQWjX2nY0_VOCL6_B_0Oq0ZW4yUoIOgyEik2gNlciolW3cshlF9OwL6MAL6MALIP_vzBUf615__rjCty3-0fgLtv8Ck</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2306307738</pqid></control><display><type>article</type><title>Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Loizeau, Andrea J ; Theill, Nathan ; Cohen, Simon M ; Eicher, Stefanie ; Mitchell, Susan L ; Meier, Silvio ; McDowell, Michelle ; Martin, Mike ; Riese, Florian</creator><creatorcontrib>Loizeau, Andrea J ; Theill, Nathan ; Cohen, Simon M ; Eicher, Stefanie ; Mitchell, Susan L ; Meier, Silvio ; McDowell, Michelle ; Martin, Mike ; Riese, Florian</creatorcontrib><description>Abstract
Background
fact Boxes are decision support tools that can inform about treatment effects.
Objectives
to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.
Design
randomized controlled trial.
Setting
Swiss-German region of Switzerland.
Subjects
two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118).
Intervention
two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month).
Methods
participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments.
Results
participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration.
Conclusions
fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers.
Trial registration
FORSbase (12091).</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afy149</identifier><identifier>PMID: 30321268</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Artificial ; Clinical trials ; Conflict ; Conflict, Psychological ; Decision makers ; Decision making ; Decision Support Techniques ; Dementia ; Dementia - complications ; Dementia - therapy ; Dementia disorders ; Editor's Choice ; Female ; Fluid Therapy - adverse effects ; Fluid Therapy - methods ; Guardians ; Humans ; Hydration ; Intervention ; Male ; Middle Aged ; Pneumonia ; Pneumonia - complications ; Pneumonia - drug therapy ; Questionnaires ; Research Paper ; Surveys and Questionnaires ; Treatment preferences</subject><ispartof>Age and ageing, 2019-01, Vol.48 (1), p.67-74</ispartof><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-8952723e2f7c96f58996d9933afad72a0ca09a0ace165006c261274984f881a13</citedby><cites>FETCH-LOGICAL-c448t-8952723e2f7c96f58996d9933afad72a0ca09a0ace165006c261274984f881a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,1579,27905,27906,30980</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30321268$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Loizeau, Andrea J</creatorcontrib><creatorcontrib>Theill, Nathan</creatorcontrib><creatorcontrib>Cohen, Simon M</creatorcontrib><creatorcontrib>Eicher, Stefanie</creatorcontrib><creatorcontrib>Mitchell, Susan L</creatorcontrib><creatorcontrib>Meier, Silvio</creatorcontrib><creatorcontrib>McDowell, Michelle</creatorcontrib><creatorcontrib>Martin, Mike</creatorcontrib><creatorcontrib>Riese, Florian</creatorcontrib><title>Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Abstract
Background
fact Boxes are decision support tools that can inform about treatment effects.
Objectives
to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.
Design
randomized controlled trial.
Setting
Swiss-German region of Switzerland.
Subjects
two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118).
Intervention
two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month).
Methods
participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments.
Results
participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration.
Conclusions
fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers.
Trial registration
FORSbase (12091).</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Artificial</subject><subject>Clinical trials</subject><subject>Conflict</subject><subject>Conflict, Psychological</subject><subject>Decision makers</subject><subject>Decision making</subject><subject>Decision Support Techniques</subject><subject>Dementia</subject><subject>Dementia - complications</subject><subject>Dementia - therapy</subject><subject>Dementia disorders</subject><subject>Editor's Choice</subject><subject>Female</subject><subject>Fluid Therapy - adverse effects</subject><subject>Fluid Therapy - methods</subject><subject>Guardians</subject><subject>Humans</subject><subject>Hydration</subject><subject>Intervention</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pneumonia</subject><subject>Pneumonia - complications</subject><subject>Pneumonia - drug therapy</subject><subject>Questionnaires</subject><subject>Research Paper</subject><subject>Surveys and Questionnaires</subject><subject>Treatment preferences</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkkuPFCEQxztG446rR6-GxIuXdnn0AzyY6MZVk0286JnU0DDLhoYW6I3jF_JrWptZx8fFC1DUr_5VFNU0Txl9yagSZ7CzPu7OwO1Zp-41G9YNsuVSdPebDaWUt3Tk6qR5VMo1mqxn_GFzIqjgjA9y0_y4AFPJ2_SNTNb44lMkZV2WlCupKYVCsp1WY49eCMSk6ILHKNimFddY_dan6k0hLmWyRLvOKXpAz0QgV--88Rh3tZ8y1NsMPhKYbiAaO6HwbFEBXhEgGSPS7L_jNSapOYWAx5rBh8fNAweh2Cd3-2nz5eLd5_MP7eWn9x_P31y2putkbaXq-ciF5W40anC9VGqYlBICHEwjB2qAKqBgLBt6SgfDB8bHTsnOScmAidPm9UF3WbeznQzWliHoJfsZ8l4n8PpvT_RXepdu9CA47ylHgRd3Ajl9XW2pevbF2BAg2rQWjX2nY0_VOCL6_B_0Oq0ZW4yUoIOgyEik2gNlciolW3cshlF9OwL6MAL6MALIP_vzBUf615__rjCty3-0fgLtv8Ck</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Loizeau, Andrea J</creator><creator>Theill, Nathan</creator><creator>Cohen, Simon M</creator><creator>Eicher, Stefanie</creator><creator>Mitchell, Susan L</creator><creator>Meier, Silvio</creator><creator>McDowell, Michelle</creator><creator>Martin, Mike</creator><creator>Riese, Florian</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190101</creationdate><title>Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail</title><author>Loizeau, Andrea J ; Theill, Nathan ; Cohen, Simon M ; Eicher, Stefanie ; Mitchell, Susan L ; Meier, Silvio ; McDowell, Michelle ; Martin, Mike ; Riese, Florian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-8952723e2f7c96f58996d9933afad72a0ca09a0ace165006c261274984f881a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Artificial</topic><topic>Clinical trials</topic><topic>Conflict</topic><topic>Conflict, Psychological</topic><topic>Decision makers</topic><topic>Decision making</topic><topic>Decision Support Techniques</topic><topic>Dementia</topic><topic>Dementia - complications</topic><topic>Dementia - therapy</topic><topic>Dementia disorders</topic><topic>Editor's Choice</topic><topic>Female</topic><topic>Fluid Therapy - adverse effects</topic><topic>Fluid Therapy - methods</topic><topic>Guardians</topic><topic>Humans</topic><topic>Hydration</topic><topic>Intervention</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pneumonia</topic><topic>Pneumonia - complications</topic><topic>Pneumonia - drug therapy</topic><topic>Questionnaires</topic><topic>Research Paper</topic><topic>Surveys and Questionnaires</topic><topic>Treatment preferences</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Loizeau, Andrea J</creatorcontrib><creatorcontrib>Theill, Nathan</creatorcontrib><creatorcontrib>Cohen, Simon M</creatorcontrib><creatorcontrib>Eicher, Stefanie</creatorcontrib><creatorcontrib>Mitchell, Susan L</creatorcontrib><creatorcontrib>Meier, Silvio</creatorcontrib><creatorcontrib>McDowell, Michelle</creatorcontrib><creatorcontrib>Martin, Mike</creatorcontrib><creatorcontrib>Riese, Florian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Loizeau, Andrea J</au><au>Theill, Nathan</au><au>Cohen, Simon M</au><au>Eicher, Stefanie</au><au>Mitchell, Susan L</au><au>Meier, Silvio</au><au>McDowell, Michelle</au><au>Martin, Mike</au><au>Riese, Florian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>48</volume><issue>1</issue><spage>67</spage><epage>74</epage><pages>67-74</pages><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Background
fact Boxes are decision support tools that can inform about treatment effects.
Objectives
to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia.
Design
randomized controlled trial.
Setting
Swiss-German region of Switzerland.
Subjects
two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118).
Intervention
two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month).
Methods
participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments.
Results
participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = −8.35, 95% Confidence Interval (CI), −12.43, −4.28) and artificial hydration (b = −6.02, 95% CI, −9.84, −2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration.
Conclusions
fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers.
Trial registration
FORSbase (12091).</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30321268</pmid><doi>10.1093/ageing/afy149</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Age and ageing, 2019-01, Vol.48 (1), p.67-74 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Applied Social Sciences Index & Abstracts (ASSIA); Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - therapeutic use Antibiotics Artificial Clinical trials Conflict Conflict, Psychological Decision makers Decision making Decision Support Techniques Dementia Dementia - complications Dementia - therapy Dementia disorders Editor's Choice Female Fluid Therapy - adverse effects Fluid Therapy - methods Guardians Humans Hydration Intervention Male Middle Aged Pneumonia Pneumonia - complications Pneumonia - drug therapy Questionnaires Research Paper Surveys and Questionnaires Treatment preferences |
| title | Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail |
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