Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 1, 2022
Date Accepted: Sep 22, 2022
Share Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction
ABSTRACT
Background:
Warfarin and non-steroidal anti-inflammatory drugs (NSAIDs) drug-drug interaction (DDI) warnings within electronic health records indicate potential harm but fail to account for contextual factors and preferences.
Objective:
The purpose of this study was to conduct a formative evaluation of a shared decision making (SDM) tool for a DDI between warfarin and NSAIDs called DDInteract that incorporated patient and product contextual factors to estimate the risk of bleeding.
Methods:
A randomized formative evaluation was conducted to compare DDInteract to usual care (UC) using physician/patient dyads in simulated clinical encounters. Participants completed a post-session interview and survey of the SDM process (SDM-9), tool usability and workload (NASA Task Load Index and Unified Theory of Acceptance and Use of Technology [UTAUT]), and perceived behavioral and decision conflict scale. They also were interviewed after the session to obtain perceptions DDInteract and UC resources for DDIs.
Results:
Twelve dyads completed the simulated encounters using virtual software. Regarding scores on the SDM-9, participants rated DDInteract higher than UC for questions pertaining to helping patients clarify the decision (p=0.035), involving patients in the decision (p=0.005), displaying treatment options (p<0.001), identifying advantages and disadvantages (p=0.008), and facilitating patient understanding (p=0.010) and discussion of preferences (p=0.007). More than half of the UTAUT constructs showed differences between the two groups, favoring DDInteract (p<0.05). During the session debrief, physicians indicated little concern for additional time or workload to use DDInteract.
Conclusions:
Participants rated DDInteract useful for enhancing SDM, logical, and would use the tool for an interaction involving warfarin and NSAIDs.
Citation
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