A Decision Aid for COPD patients considering inhaled steroid therapy: development and before and after pilot testing

We developed a DA for COPD patients considering inhaled steroid therapy using the Ottawa Decision Support Framework, the best available evidence for using inhaled steroid in COPD and the expected utility model. The development process involved patients, pulmonologists, DA developers and decision making experts. We pilot tested the DA with 8 COPD patients who completed an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.The DA is a computer-based interactive tool incorporating four different decision making models. In the first part, the DA provides information about COPD as a disease, the different treatment options, and the benefits and downsides of using inhaled steroids. In the second part, it coaches the patient in the decision making process through clarifying values and preferences. Patients evaluated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).We have developed a computer-based interactive DA for COPD patients considering inhaled steroids serving as a model for other DAs in COPD, in particular related to inhaled therapies. Future research should assess the DA effectiveness.Increasingly, patients want to become actively involved in medical decision-making [1]. Active patient involvement can improve outcomes including quality of life and can possibly reduce health care expenditures [2-4]. However, therapy and screening decisions are complicated for several reasons. First, there is often no single 'best' choice because people vary in the values or personal importance that they place on the benefits and harms of different treatment or screening options. Second, the evidence needed to trade off benefits and downsides (harm, burden and cost) of options may be of low quality. Third, clinicians have little knowledge about the best ways to present evidence and to involve patients in the decision making process. Indi