Shared decision making is the foundation of modern patient-centered medical care. Ideally, in shared decision making, clinicians offer information on treatment options, and patients clarify their concerns and preferences that might affect their choices. However, clinicians often lack the required information and the time to explore all the pros and cons of each therapeutic option with patients. Patient decision aids help solve this problem, and have evolved into critical tools for supporting shared decision making in medical settings. As a result, international standards now exist for how decision aids should be developed, and there are online repositories of high quality decision aids. However, to our knowledge, no decision aid exists for patients with alcohol use disorders (AUD) despite the availability of multiple evidence- based treatments. OBJECTIVES: The proposed rigorous 18-month study will develop a high quality patient decision aid for AUD consistent with international standards.
Specific aims are: 1) to understand the needs of patients, family members, and clinicians regarding shared decision making for AUD;2) to systematically review the available evidence on the efficacy and risks of AUD treatment options that should be offered to adult patients;and 3) to develop and conduct initial field tests of a decision aid for shared decision making with patients with AUD. METHODS: This study will be conducted in a large regional health care system. We will use semi-structured interviews with patients with AUD, and focus groups with family members of patients with AUD and clinicians, to understand user needs (Aim 1). We will systematically review the literature on the benefits and risks of 9 evidence-based treatments currently recommended by high-quality clinical practice guidelines (Aim 2): 5 behavioral treatments (cognitive behavioral therapy, motivational enhancement therapy, behavioral couples therapy, 12-step facilitation, and community reinforcement);and 4 medications (naltrexone, acamprosate, disulfiram, topiramate). A patient decision aid will be developed based on Aims 1-2 findings, guided by an interdisciplinary Steering Committee (Aim 3). The clarity and acceptability of the decision aid will be assessed using cognitive interviews with users (alpha testing). Initial field tests of the usability of the decision aid (beta testing) will be conducted with 20 patients with AUD and the clinicians who care for them to assess its effect on shared decision making. PUBLIC HEALTH IMPACT: This study will develop an innovative tool for engaging patients with AUD in treatment. Moreover, this line of research has the potential to transform the management of AUD in health care settings, moving beyond the current non- individualized approach of "referral to treatment" to a patient-centered approach based on shared decision making. Such a transformation could bring patient-centered care to AUD management in medical settings.

Public Health Relevance

Patient-centered medical care includes shared decision making between patients and care providers. Patient decision aids are print, video, and online resources that help facilitate shared decision making by giving patients information about their condition and its treatments. However, patients with alcohol use disorders are not typically offered shared decision making, and no patient decision aids address treatment options for alcohol use disorders. This study will develop and test a patient decision aid to support shared decision making for patients with alcohol use disorders so they can make informed choices about treatment.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Exploratory/Developmental Grants (R21)
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Health Services Research Review Subcommittee (AA)
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Ducharme, Lori
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Group Health Cooperative
United States
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