Development of a Patient Decision Aid for the Treatment of Osteoporosis Among Filipino Postmenopausal Women

Ma. Carrissa Abigail Roxas; Cecilia Jimeno; Lia Palileo-Villanueva; Anna Angelica Macalalad-Josue; Mark Anthony Sandoval; Jose Alberto Fernandez

doi:10.15605/jafes.035.01.15

Authors

Ma. Carrissa Abigail Roxas University of the Philippines-Philippine General Hospital https://orcid.org/0000-0002-2864-2879
Cecilia Jimeno University of the Philippines-Philippine General Hospital
Lia Palileo-Villanueva University of the Philippines Manila https://orcid.org/0000-0002-4635-140X
Anna Angelica Macalalad-Josue University of the Philippines-Philippine General Hospital
Mark Anthony Sandoval University of the Philippines-Philippine General Hospital
Jose Alberto Fernandez University of the Philippines Diliman https://orcid.org/0000-0002-3935-1575

DOI:

https://doi.org/10.15605/jafes.035.01.15

Keywords:

patient decision aid, shared decision-making, osteoporosis, treatment

Abstract

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.

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Author Biographies

Ma. Carrissa Abigail Roxas, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism

Cecilia Jimeno, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

College of Medicine, University of the Philippines Manila,

Lia Palileo-Villanueva, University of the Philippines Manila

College of Medicine

Anna Angelica Macalalad-Josue, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

Mark Anthony Sandoval, University of the Philippines-Philippine General Hospital

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine

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