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IIR 07-266 – HSR&D Study

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IIR 07-266
Decision Aid in Veterans with Post Traumatic Stress Disorder
Bradley V Watts MD MPH
White River Junction VA Medical Center, White River Junction, VT
White River Junction, VT
Funding Period: July 2008 - June 2011

BACKGROUND/RATIONALE:
Post-traumatic stress disorder (PTSD) is a severe and often disabling condition affecting millions of Veterans. Within VA, significant staffing and financial resources are devoted to the mission of treating PTSD, and the anticipated need for treatment is expected to accelerate.

Research over the past two decades has identified a number of successful strategies for the treatment of PTSD, including both psychotherapy and pharmacology. Despite this knowledge, many veterans with PTSD do not receive an evidence-based treatment. Among the group of proven effective treatments, the patient time commitment and potential adverse effects differ considerably. Patients with PTSD are often ill informed about the available treatments, and there has been little formal effort aimed at matching the patient's preference to a specific treatment.

OBJECTIVE(S):
Our objectives are to examine the effects of a decision aid on veterans with PTSD presenting for care. There are several important parts of that objective: (1) Will use of the decision aid cause patients to make better quality decisions about PTSD treatment? (2) Will use of the decision aid result to more satisfied and more adherent patients? (3) Will use of the decision aid result lead more evidence-based treatments?

METHODS:
This study is a randomized clinical trial comparing 66 patients who view a decision aid just after presenting for care with 66 patients receiving the usual treatment provided. The intervention group will view a decision aid for PTSD just before their initial evaluation. Patients knowledge, satisfaction, and certainty with their decision will be measured just after the evaluation for both groups. Patients will then be followed for six months to access their use of evidence-based treatments and overall PTSD symptoms.


FINDINGS/RESULTS:
Sixty-six patients were randomized into the DA group, and 66 patients into the TAU group. Groups did not differ based on gender, race, age, marital status, veteran era, and PTSD severity score. Analyses determined that patients who saw the decision aid were more knowledgeable regarding PTSD; the PTSD knowledge score was 18 in the decision aid group compared to 13.3 in the control group (p<0.001). In addition, the Veterans who were randomized to receive the decision aid showed less decisional conflict with their PTSD treatment decisions (DA=32.7 vs. 47.2 for controls, p<0.001). Both groups appeared equally satisfied with their mental health visit (4.42 vs. 4.42, p=0.98).
The use of the decision aid also appeared to affect the process of care. While a similar percentage of Veterans received evidence based treatments for PTSD, those patients who saw the decision aid were more likely to receive their preferred treatment (decision aid 20% vs. 6% for controls p<0.04). While the study was not powered to detect changes in PTSD symptom outcomes, the decision aid exposed group showed a significant reduction in PTSD scores (PCL 61.2 to 55.5, p<0.01) whereas the control group did not (PCL 64.7-61.7, p=0.3).

IMPACT:
The use of a patient decision aid appears to result in patients who are more knowledgeable and confident about their their treatment choices. It appears the use of the decision aid may foster care more consistent with the patient preferences. This easy to use intervention could potentially be disseminated to provide more Veteran centered care for those with PTSD.

PUBLICATIONS:

Journal Articles

  1. Mills PD, Watts BV, Miller S, Kemp J, Knox K, DeRosier JM, Bagian JP. A checklist to identify inpatient suicide hazards in veterans affairs hospitals. Joint Commission Journal on Quality and Patient Safety. 2010 Feb 1; 36(2):87-93.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Decision-Making, PTSD
MeSH Terms: none

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