Efficacy of a patient decision aid for improving person-centered decision-making by older adults with obstructive sleep apnea

Abstract

Study objectives: Person-centered obstructive sleep apnea (OSA) care is a collaborative approach that is respectful of an individual's health priorities. Informed decision-making is essential to person-centered care, especially as patients age. In a feasibility study, we evaluated the effects of a new decision aid (Decide2Rest) on OSA treatment decision-making in older adults.

Methods: Patients (aged ≥ 60 years) with newly diagnosed OSA were recruited from two health care systems and randomized either to Decide2Rest or to a control program. Postintervention outcomes included 1) Decisional Conflict Scale (0-100, where 0 = low and 100 = high conflict), which measures perceptions of uncertainty, whether decisions reflect what matters most to patients, and whether patients feel supported in decision-making; 2) Preparation for Decision-Making scale (0-100, where 0 = least and 100 most prepared); and 3) OSA knowledge (0-100, where 0 = poor and 100 = outstanding). Multivariable linear regression models examined relationships between Decide2Rest and outcomes (Decisional Conflict Scale, Preparation for Decision-Making, OSA knowledge).

Results: Seventy-three patients were randomized to Decide2Rest (n = 36; mean age, 69 years; 72% male) vs control (n = 37; mean age, 69 years; 70% male). Results from the regressions, controlling for study site, indicate that the Decide2Rest program resulted in less decisional conflict (20.5 vs 32.7 on the Decisional Conflict Scale; P = .014), more preparedness for decision-making (87.8 vs 66.2 on the Preparation for Decision-Making scale; P < .001), and greater OSA knowledge (75.1 vs 65.3 OSA knowledge score; P = .04) scores than in the control group.

Conclusions: The Decide2Rest program promotes person-centered OSA decision-making for older patients with newly diagnosed OSA. Future studies are needed to optimize implementation of the program.

Clinical trial registration: Registry: ClinicalTrials.gov, Name: Improving Older Adults' Decision-Making for OSAT (eDecide2Rest); URL: https://ichgcp.net/clinical-trials-registry/NCT03138993; Identifier: NCT03138993.

Keywords: aging; decision-making; obstructive sleep apnea; patient autonomy.

Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was conducted at the Veterans Administration Greater Los Angeles Healthcare System and the UCLA Health System. The authors have no financial or nonfinancial interests that are relevant to the submitted manuscript. This study was funded by the National Institute on Aging of the National Institutes of Health (K23AG045937 to C.H.F., K23AG055668 to Y.S., K23AG049955 to J.D., National Center for Advancing Translational Science, UCLA CTSI Grant UL1TR001881), as well as the American Federation for Aging Research, The John A. Hartford Foundation, and The Atlantic Philanthropies (The Beeson Career Development in Aging Research Award Program to C.H.F.). R.D.H. received support from the University of California, Los Angeles Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under the National Institutes of Health National Institute on Aging Grant P30-AG021684. J.L.M. received support from the National Heart, Lung and Blood Institute at the National Institutes of Health (K24HL143055).

© 2021 American Academy of Sleep Medicine.

Figures

Figure 1. Study flow diagram.

Figure 2. Mean scores.

Mean scores of Decisional Conflict Scale (DCS) with subscales. (A) Higher scores suggest more decisional conflict, Preparation for Decision-Making (PDM) scale, (B) Higher scores are indicative of feeling more prepared for decision-making, and OSA Knowledge score (C) Higher scores are indicative of greater OSA knowledge. The means were estimated from the unadjusted multivariable regression, controlling for study site. * P < .05, ** P < .005, and *** P < .0001.