Development of a Patient Decision Aid for the Treatment of Osteoporosis Among Filipino Postmenopausal Women
Keywords:patient decision aid, shared decision-making, osteoporosis, treatment
Background. Guidelines for osteoporosis have provided recommendations on when to offer pharmacologic management for postmenopausal women, but do not specify which “best” medication to start. The choice of therapy depends on the efficacy, safety/tolerability of the drug and the patient’s profile and preferences. Patient decision aids (PtDA) are tools designed to facilitate shared decision-making (SDM) between the patient and health care provider for conditions where there are several available options, and the “best” choice is unclear. We aimed to develop a culturally acceptable patient
decision aid on the treatment of osteoporosis among Filipino postmenopausal women at risk of osteoporotic fractures.
Methodology. A qualitative approach and an iterative process was employed in this study following the guidance of the International Patient Decision Aid Standards (IPDAS). Phase 1 (Needs Assessment) involved interviews with 8 physicians who are involved in the care of women with osteoporosis and focus group discussions with 19 postmenopausal women with osteoporosis who have received treatment. Phase 2 (PtDA Development) involved a systematic review of evidence and development of an initial prototype through several iterations with an expert panel. The final prototype was pilot tested in actual clinical encounters (Phase 3).
Results. The final PtDA consists of 6 laminated flashcards, which illustrate the different considerations that are important to patients when selecting an anti-osteoporosis treatment (efficacy, method, frequency of administration, side effects and cost), and a fracture worksheet to illustrate individualized effects of the treatments on the patient's fracture risk. These are accompanied by a clinician guide on how to use the PtDA during consultations, which includes information on non-pharmacologic management of osteoporosis. The PtDA was acceptable to physicians and patients.
Conclusion. With the integration of decisional needs assessment, clinical expertise, user preference and iterative revision testing, we were able to develop a culturally adapted PtDA on the treatment of osteoporosis among Filipino postmenopausal woman at risk of osteoporotic fractures for use during clinical encounters.
Mithal A, Ebeling P. The Asia-Pacific Regional Audit: Epidemiology, costs & burden of osteoporosis in 2013. https://www.iofbonehealth.org/sites/default/files/media/PDFs/Regional%20Audits/2013-Asia_Pacific_Audit_0_0.pdf.
Tabatabaei-Malazy O, Salari P, Khashayar P, Larijani B. New horizons in treatment of osteoporosis. Daru. 2017;25(1):2. https://www.ncbi.nlm.nih.gov/pubmed/28173850. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297185. https://doi.org/10.1186/s40199-017-0167-z.
The Lancet Diabetes Endocrinology. Osteoporosis: A roadmap to close the treatment gap. Lancet Diabetes Endocrinol. 2018;6(11):833. https://www.ncbi.nlm.nih.gov/pubmed/30322720. https://doi.org/10.1016/s2213-8587(18)30292-4.
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359-81. https://www.ncbi.nlm.nih.gov/pubmed/25182228l. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176573. https://doi.org/10.1007/s00198-014-2794-2.
Dirksen CD. The use of research evidence on patient preferences in health care decision-making: Issues, controversies and moving forward. Expert Rev Pharmacoecon Outcomes Res. 2014;14(6):785-94.
Emkey R, Koltun W, Beusterien K, et al. Patient preference for once-monthly ibandronate versus once-weekly alendronate in a randomized, open-label, cross-over trial: the Boniva Alendronate Trial in Osteoporosis (BALTO). Curr Med Res Opin. 2005;21(12):1895-903. https://www.ncbi.nlm.nih.gov/pubmed/16368038. https://doi.org/10.1185/030079905x74862.
Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R. Patient-reported barriers to osteoporosis therapy. Arch Osteoporos. 2016;11(1):19. https://www.ncbi.nlm.nih.gov/pubmed/27129487. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851700. https://doi.org/10.1007/s11657-016-0272-5.
Rabenda V, Reginster JY. Overcoming problems with adherence to osteoporosis medication. Expert Rev Pharmacoecon Outcomes Res. 2010;10(6):677-89. https://www.ncbi.nlm.nih.gov/pubmed//21155701. https://doi.org/10.1586/erp.10.76.
Keirns CC, Goold SD. Patient-centered care and preference-sensitive decision-making. JAMA. 2015;302(16):1805-6. https://www.ncbi.nlm.nih.gov/pubmed/19861674.https://doi.org/10.1001/jama.2009.1550.
Joosten EAG, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CPF, de Jong CAJ. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219-26. https://www.ncbi.nlm.nih.gov/pubmed/18418028. https://doi.org/10.1159/000126073.
Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014;(1):CD001431. https://www.ncbi.nlm.nih.gov/pubmed/24470076. https://doi.org/10.1002/14651858.cd001431.pub4.
Cranney A, O’Connor AM, Jacobsen MJ, et al. Development and pilot testing of a decision aid for postmenopausal women with osteoporosis. Patient Educ Couns. 2002;47(3):245-55. https://www.ncbi.nlm.nih.gov/pubmed/12088603. https://doi.org/10.1016/s0738-3991(01)00218-x.
Pencille LJ, Campbell ME, Van Houten HK, et al. Protocol for the osteoporosis choice trial. A pilot randomized trial of a decision aid in primary care practice. Trials. 2009;10:113. https://www.ncbi.nlm.nih.gov/pubmed/20003299.
Montori VM, Shah ND, Pencille LJ, et al. Use of a decision aid to improve treatment decisions in osteoporosis : The osteoporosis choice randomized trial. Am J Med. 2011;124(6):549-56. https://www.ncbi.nlm.nih.gov/pubmed/21605732. https://doi.org/10.1016/j.amjmed.2011.01.013
O’Connor A, Llewellyn-Thomas H, Stacey D, eds. IPDAS collaboration background document. 2005. http://ipdas.ohri.ca/IPDAS_Background.pdf
Royal Osteoporosis Society. Drug treatments for osteoporosis: Zoledronic acid (Aclasta). https://theros.org.uk/media/2cmhexi4/roszoledronic-acid-fact-sheet-january-2016.pdf.
Royal Osteoporosis Society. Drug treatments for osteoporosis: Parathyroid hormone treatment [teriparatide (Forsteo Movymia, Terrosa)]. https://theros.org.uk/media/yt1loo5s/ros-parathyroidhormone-treatment-fact-sheet-december-2019.pdf.
Royal Osteoporosis Society. Drug treatments for osteoporosis: Risedronate (risedronate sodium, Actonel). https://theros.org.uk/media/txupx3ve/ros-risedronate-fact-sheet-january-2016.pdf.
Royal Osteoporosis Society. Drug treatments for osteoporosis: Raloxifene (Evista). https://strwebstgmedia.blob.core.windows.net/media/xmfjjuek/raloxifene-evista-fact-sheet-june-2017.pdf.
Royal Osteoporosis Society. Drug treatments for osteoporosis: Ibandronate (Bonviva). https://strwebstgmedia.blob.core.windows.net/media/3n3ni0w0/ibandronate-bonviva-fact-sheet-january-2016.pdf.
Royal Osteoporosis Society: Drug treatments for osteoporosis: Denosumab (Prolia). https://strwebstgmedia.blob.core.windows.net/media/sxif4dxc/denosumab-prolia-fact-sheet-octobe-2017.pdf.
Royal Osteoporosis Society. Drug treatments for osteoporosis: Alendronate (alendronic acid or Fosamax). https://theros.org.uk/media/lcwnpxth/ros-alendronic-acid-and-osteoporosis-fact-sheetaugust-2017.pdf.
Jansen JP, Bergman GJD, Huels J, Olson M. The efficacy ofbisphosphonates in the prevention of vertebral, hip, and nonvertebral-nonhip fractures in osteoporosis: A network meta-analysis. Semin Arthritis Rheum. 2011;40(4):275-84.e2. https://www.ncbi.nlm.nih.gov/pubmed/20828791. https://doi.org/10.1016/j.semarthrit.2010.06.001.
Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361(8):756-65. https://www.ncbi.nlm.nih.gov/pubmed/19671655. https://doi.org/10.1056/nejmoa0809493.
Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-41.
Chewning B, Bylund CL, Shah B, et al. Patient preferences for shared decisions: A systematic review. Patient Educ Couns. 2012;86(1):9-18. https://www.ncbi.nlm.nih.gov/pubmed/21474265.
Bae JM. Shared decision-making: relevant concepts and facilitating strategies. Epidemiol Health. 2017;39:e2017048. https://www.ncbi.nlm.nih.gov/pubmed/29092391.
Becerra-Pérez MM, Menear M, Turcotte S, Labrecque M, Légaré F. More primary care patients regret health decisions if they experienced decisional conflict in the consultation: A secondary analysis of a multicenter descriptive study. BMC Fam Pract. 2016;17(1):156. https://www.ncbi.nlm.nih.gov/pubmed/27832752. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103443. https://doi.org/10.1186/s12875-016-0558-0.
Becerra-Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and predictors of decision regret about health care decisions: A systematic review. Med Decis Making. 2016;36(6):777-90. https://www.ncbi.nlm.nih.gov/pubmed/26975351. https://doi.org/10.1177/0272989x16636113.
Rashidian H, Nedjat S, Majdzadeh R, et al. The perspectives of Iranian physicians and patients towards patient decision aids : A qualitative study. BMC Res Notes. 2013;6:379. https://www.ncbi.nlm.nih.gov/pubmed/24066792.
Hiligsmann M, Ronda G, van der Weijden T, Boonen A. The development of a personalized patient education tool for decision making for postmenopausal women with osteoporosis. Osteoporos Int. 2016;27(8):2489-96. https://www.ncbi.nlm.nih.gov/pubmed/27048388. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947108.
McCaffery KJ, Smith SK, Wolf M. The challenge of shared decision making among patients with lower literacy: A framework for research and development. Med Decis Making. 2010;30(1):35-44.
Akl EA, Oxman AD, Herrin J, et al. Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database Syst Rev. 2011;2011(3):CD006776. https://www.ncbi.nlm.nih.gov/pubmed/21412897. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464912. https://doi.org/10.1002/14651858.cd006776.pub2.
Garcia-Retamero R, Cokely ET. Communicating health risks with visual aids. Curr Dir Psychol Sci. 2013;22(5):392-9. https://doi.eorg/10.1177%2F0963721413491570.
Durand MA, Carpenter L, Dolan H, et al. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9(4):e94670.
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