From: A `combined framework’ approach to developing a patient decision aid: the PANDAs model
Steps | Framework | Objectives | Methods | Outcome |
---|---|---|---|---|
1. Convene an expert panel | UKMRC/IPDAS | • To guide the development of the PDA, including determining the clinical focus, needs assessment, research methods, content and format of the PDA, as well as evaluation and implementation | • Expert consensus (face-to-face meetings) | • Ten stakeholders were selected, including general practitioners, diabetologist, diabetes educator, expert patients, representative from Diabetes UK, patient decision support experts, statistician |
• Four meetings were conducted during the one-year period | ||||
2. Assess users’ needs | UKMRC/ IPDAS | • To assess the needs of patients with type 2 diabetes who are making treatment decisions | • Individual patient and clinician interviews | • Nine patients at the point of decision making and 14 general practitioners, nurses and dieticians involved in diabetes care were interviewed |
• To assess the needs of clinicians who are supporting patients’ decision making | • The users identify decisional, emotional, information and social support needs | |||
• To determine the preferred decision support tool and its mode of delivery | • A paper-based decision support tool is preferred | |||
3. Review the literature | UKMRC/ IPDAS | • To identify the range of effective decision support tools (general) | • Literature review | • PDA was selected as the decision support tool with the most evidence [10] |
• Identify existing decision support tool for diabetes treatment (specific) | • Decision support tools were identified [Decision Aid Library Inventory http://decisionaid.ohri.ca] | |||
4. Identify the theoretical framework | UKMRC | • To review the existing decision support theories | • Literature review | • Ottawa decision support framework was selected as it was the most used and implemented [11] |
5. Collate the clinical evidence for treatment options | IPDAS | • To search, select and synthesise the evidence of the pros and cons of the treatment options | • Literature review, focusing on systematic reviews and local/national clinical practice guidelines | • There was a lack of systematic reviews on the efficacy and safety of insulin vs oral oral hypoglycaemic agents. Evidence was synthesized from cohort studies [12] |
6. Drafting of the PDA (Alpha testing I) | IPDAS/UKMRC | • The design the PDA (content and format) team and PDA design expert drafted the PDA iteratively | • Draft-review-revise iterative process by the research team and PDA design experts | • The preliminary draft of the PDA was developed based on the IPDAS criteria and went through 13 iterations between the researchers and PDA design experts |
7. Review by the expert panel (Alpha testing II) | IPDAS/UKMRC | • To review the PDA by the stakeholders (not part of research team) | • Expert panel consensus (meetings and emails) | • The research team and the PDA design experts discussed the feedback and agreed on the final draft for beta testing |
8. Develop the PDA training module for clinicians | • To develop a training module, including a guidebook and workshop, to guide clinicians on how to use the PDA with the patients | • Expert consensus involving research team, decision support experts, diabetes educator and medical education expert | • A PDA guidebook for clinicians | |
• A 1-2 hour workshop involving short lectures, demonstration and feedback | ||||
9. Assess the readability | IPDAS | • To assess the readability of the PDA | • Readability Calculations v7.0 software | • The readability was at grade 8 (or English year 9) using SMOG and Fry |
10. Review by patients and clinicians (Beta testing) | IPDAS | • To assess the acceptability and feasibility of the PDA in real consultations | • Patient and clinician questionnaire survey | • Nine patients and 14 clinicians found the PDA acceptable and feasible |
• Individual interviews with patients and clinicians | ||||
11. Finalise the PDA | IPDAS | • To finalise the content, design and quantity to be printed | • Research team and PDA design expert consensus | • A 16-paged paper PDA was developed |
• To declare conflict of interest, next update |