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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3076 — Effects of a Patient Decision Aid for Veterans with Post-Tramatic Stress Disorder (PTSD)

Watts BV, White River Junction VAMC; Schnurr PP, VA National Center for PTSD; Zayed M, White River Junction VAMC; Sinnott PL, HERC;

VHA seeks to deliver care that is consistent with Veterans' preferences. This requires engagement in treatment decision-making. Patient decision aids are tools developed to assist patients with understanding their conditions and treatment options. We sought to develop and test a decision aid developed for Veterans with PTSD.

Following a comprehensive review of the treatment literature, we developed a decision aid for Veterans with PTSD through an iterative process using patient feedback. Veterans with PTSD presenting for an initial visit in mental health were randomly assigned to receive treatment as usual or treatment as usual plus the decision aid. Veterans reviewed the decision aid just prior to seeing their mental health provider. We collected data regarding patients’ treatment preferences, knowledge about PTSD treatment, comfort with treatment decisions, decisional conflict, and satisfaction at the initial visit and 6 months after the initial visit. In addition, we collected information regarding which treatments Veterans received and PTSD outcomes in the six months following the initial assessment.

132 Veterans were randomized and entered the study. The study population was largely white (98.2%) and male (92.1%). The average age was 48.5 years old, with an equal division between Vietnam Veterans, Iraq and Afghanistan Veterans, and Veterans of other eras. Veterans randomized to review the decision aid showed enhanced knowledge and decreased decisional conflict when compared to Veterans who did not receive the decision aid. Both groups had similar levels of satisfaction. Those who were randomized to receive the decision aid were more likely to receive their preferred evidence-based treatment for PTSD over their first six months in treatment. There was a trend for better PTSD outcomes for those exposed to the decision aid.

Our patient decision aid was successfully used in a clinical setting. This low cost intervention resulted in improved knowledge about PTSD treatments and greater confidence in treatment decisions. Patients reviewing the decision aid were more likely to receive their preferred evidence-based treatment and had trend toward better outcomes.

Use of the patient decision aid for PTSD appears to result in more Veteran-centered care.

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