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Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail


Loizeau, Andrea; Theill, Nathan; Cohen, Simon M; Eicher, Stefanie; Mitchell, Susan L; Meier, Silvio; McDowell, Michelle; Martin, Mike; Riese, Florian (2019). Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail. Age and Ageing, 48(1):67-74.

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

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).

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Institute of Psychology
06 Faculty of Arts > Center for Gerontology
08 Research Priority Programs > Dynamics of Healthy Aging
Dewey Decimal Classification:150 Psychology
Language:English
Date:1 January 2019
Deposited On:31 Jan 2019 10:18
Last Modified:01 Feb 2019 11:01
Publisher:Oxford University Press
ISSN:0002-0729
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/ageing/afy149
Official URL:https://forsbase.unil.ch/project/study-public-detail/15565/
PubMed ID:30321268
Project Information:
  • : FunderSwiss Academy of Medical Sciences
  • : Grant IDPC 22/14
  • : Project TitleResearch in Palliative Care
  • : FunderStanley Thomas Johnson Foundation
  • : Grant ID
  • : Project Title
  • : FunderGottfried and Julia Bangerter-Rhyner Stiftung
  • : Grant ID
  • : Project Title
  • : FunderSNSF
  • : Grant IDP1ZHP3_171747
  • : Project TitleEntscheidungs-Unterstützung für Belastende Medizinische Interventionen bei Menschen mit Demenz am Lebensende (DemFACTS)
  • : FunderUnited States National Institute of Health—National Institute on Aging
  • : Grant IDNIH-NIA R01 AG032982, NIH-NIA R01 AG043440, NIH-NIA K24AG033640 to SLM
  • : Project Title

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