Co-design and user-testing a decision aid for patients considering surgery for sciatica

Abstract

Background: Decision aids are an evidence-based clinical tool that can help guide patients through difficult health decisions. This study reports on development of a decision aid for patients with sciatica who are deciding whether to have surgery or ‘wait and see’ (i.e. try non-surgical management first).   Methods: A prototype was developed by integrating relevant research with working group perspectives (patient and clinician), decision aid standards and health literacy guidelines. The prototype was iteratively refined through user-testing (semi-structured interviews with think-aloud protocol).   Results: Across seven rounds of user-testing, clinicians (N=20) rated the resource 5.9 out of 7 (SD=1.0) for perceived usefulness, and 6.0 out of 7(SD=0.8) for perceived ease of use. Patients (N=20) reported the decision aid was easy to understand, on average correctly answering 3.4 out of 5 knowledge questions (SD=1.2) about surgery for sciatica. The grade reading score for the website was 9.0. Patients also scored highly on preparation for decision-making (4.4 out of 5, SD=0.7) suggesting strong potential to empower patients. Interview feedback showed patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values.   Conclusions: Clinicians found the decision aid acceptable, patients found it was easy to understand, and both groups felt it would empower patients to actively engage in their care and come to an informed decision that aligned with personal values. Input from the consumer working group and user-testing were crucial for ensuring that the decision aid met patient and clinician needs.