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The efficacy of a patient decision aid for improving person-centered decision-making in older adults with obstructive sleep apnea.

STUDY OBJECTIVES
Person-centered obstructive sleep apnea (OSA) care is a collaborative approach that is respectful of an individual's health priorities. Informed decision-making is essential to person-centered care, especially as patients age. In a feasibility study, we evaluated the effects of a new decision aid (Decide2Rest) on OSA treatment decision-making in older adults.


METHODS
Patients (aged ≥ 60 years) with newly diagnosed OSA were recruited from two healthcare systems and randomized to either Decide2Rest or a control program. Post-intervention outcomes included 1) Decisional Conflict Scale (DCS; 0-100 where 0=low and 100=high conflict), which measures perceptions of uncertainty, whether decisions reflect what matters most to patients and whether patients feel supported in decision making, 2) Preparation for Decision Making scale (PDM; 0-100 where 0=least and 100 most prepared), and OSA knowledge (0-100 where 0=poor and 100 outstanding). Multivariable linear regression models examined relationships between Decide2Rest and outcomes (DCS, PDM, OSA knowledge).


RESULTS
73 patients were randomized to Decide2Rest (N=36; mean age 69 years; 72% male) versus control (N= 37; mean age 69 years; 70% male). Results from the regressions, controlling for study site, indicated that the Decide2Rest program resulted in less decisional conflict (20.5 versus 32.7 on the DCS; p=.014), more preparedness for decision-making (87.8 versus 66.2 on the PDM scale; p<.001), and greater OSA knowledge (75.1 versus 65.3 OSA knowledge score; p=.04) scores than the control group.


CONCLUSIONS
The Decide2Rest program promotes person-centered OSA decision-making for older patients with newly diagnosed OSA. Future studies are needed to optimize implementation of the program.


CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov, Title: Improving Older Adults' Decision Making for OSAT (eDecide2Rest), Identifier: NCT03138993, URL: https://clinicaltrials.gov/ct2/show/NCT03138993.