Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial

<div><p>Background</p><p>Not providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma.</p><p>Methods</p><p>A parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score –37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models.</p><p>Results</p><p>Fifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9–23.2] to 25.1 [23.1–27.0] in the education + DA group (<i>P</i> = 0.0002) and from 24.0 [22.3–25.7] to 26.0 [24.0–28.0] in the education group (<i>P</i> = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups.</p><p>Conclusions</p><p>Education improved knowledge, decisional conflict, and asthma control whether the DA was added or not.</p></div

Two-month within- and between-group changes in scores on the informed, values clarity, support, uncertainty, and effective decision subscales of the DCS (<i>N</i> = 51).

<p>Two-month within- and between-group changes in scores on the informed, values clarity, support, uncertainty, and effective decision subscales of the DCS (<i>N</i> = 51).</p

The experience and the meaning of home, by Després and Lord (2005).

<p>The experience and the meaning of home, by Després and Lord (2005).</p

Flow chart.

<p>Flow chart.</p

Factors influencing the housing decision of older adults, classified by the meaning and experience of home dimensions.

<p>(A) Factors are classified by their overall reported effect (E) on the housing decision of older adults. The ones closer to the center have a greater effect. (B) Italics: Factors for which a discrepancy was identified between studies with different methods.</p

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

<div><p>Background</p><p>Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults.</p><p>Methods</p><p>We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home.</p><p>Results</p><p>The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence.</p><p>Conclusion</p><p>A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.</p></div

Flow of participants through the study.

<p><b>CONSORT flow diagram.</b> Adapted from the CONSORT 2010 Flow Diagram [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0170055#pone.0170055.ref058" target="_blank">58</a>].</p

Standardized path analysis coefficients for control group at study entry, showing attitude, perceived behavioral control and subjective norm as predictors of physicians’ behavioral intentions to engage in SDM and to follow CPGs; and showing the influence of the intention to engage in SDM on the intention to follow CPGs and vice versa (vertical arrows).

<p>Standardized path analysis coefficients for control group at study entry, showing attitude, perceived behavioral control and subjective norm as predictors of physicians’ behavioral intentions to engage in SDM and to follow CPGs; and showing the influence of the intention to engage in SDM on the intention to follow CPGs and vice versa (vertical arrows).</p

Standardized path analysis coefficients for experimental group at study entry, showing attitude, perceived behavioral control and subjective norm as predictors of physicians’ behavioral intentions to engage in SDM and to follow CPGs; and showing the influence of the intention to engage in SDM on the intention to follow CPGs and vice versa (vertical arrows).

<p>Standardized path analysis coefficients for experimental group at study entry, showing attitude, perceived behavioral control and subjective norm as predictors of physicians’ behavioral intentions to engage in SDM and to follow CPGs; and showing the influence of the intention to engage in SDM on the intention to follow CPGs and vice versa (vertical arrows).</p

Factors associated with the housing decision, classified according to the dimensions of the meaning and experience of home, by type of research design, strength of evidence and effect (N = 86).

<p>Factors associated with the housing decision, classified according to the dimensions of the meaning and experience of home, by type of research design, strength of evidence and effect (N = 86).</p