Osteoporosis decision aids inadequately address patient needs
Decision aids for osteoporosis currently lack quality standards and do not meet patient needs, results of a mixed-methods study showed.
Previously published data indicate that osteoporosis-related mortality and morbidity costs in United States totaled approximately $17 billion in 2005 and involved about 432,000 hospital admissions, approximately 180,000 nursing home admissions and about 2.5 million office visits. These statistics could increase 50% by 2025, researchers noted, adding that the lifetime risk for any osteoporotic fracture is up to 50% for women and up to 22% for men, “a markedly higher risk when compared with other major diseases.”
Zoe Paskins, senior lecturer in rheumatology at the Primary Care Centre Versus Arthritis at Keele University in Staffordshire, United Kingdom, told Healio Primary Care that “since many patients choose not to take osteoporosis medicines, the ability of clinicians to adequately explain risks and benefits to patients in the context of osteoporosis has been questioned.”
Paskins and colleagues performed a systematic review of seven biomedical literature databases and an environmental scan of a decision aids database, social media and Google. These searches yielded six studies — five randomized controlled trials and a pseudo-experimental before and after study — that included 507 participants and 11 decision aids. Paskins and colleagues’ review was also based on notes from focus group sessions held with an osteoporosis patient advisory group.
The researchers wrote that the decision aids “showed promise in increasing the accuracy of risk perception and shared decision-making yet fail to comprehensively meet international quality standards and patient needs,” so the development of new aids is warranted. Specifically, the focus group indicated that the “ideal decision aid” would be computerized, web-based, applicable during finite physician office visits, contain written and visual information about medication treatment and provide personalized risk assessment. Focus group participants also expressed the importance of receiving consistent messages across primary and secondary care and therefore, urged primary care practitioners’ input in the development of any new decision aid.
Until new decision aids can be developed, Paskins said physicians may want to consider using the Mayo Choice Tool with patients who might have, or already have, osteoporosis.
“This tool was most preferred by our patients and is freely available,” she said. “Clinicians can also still use the principles of shared decision-making and ensure their explanations cover information about the condition, its controllability and consequences of non-treatment, use simple frequencies to explain risks and benefits and incorporate the patient's values into the discussion of pros and cons.”