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Table 1. Substantive Findings on the Effects of Patient Informatics Tools and Decision Aids

Use of Tools

  • Informatics tools have been used with a variety of patients.
  • Use of tools by eligible patients is quite variable.
  • Use can be quite limited in the face of operational barriers such as requirements for a second patient visit.

Research Questions:

  1. What factors promote use?
  2. What are the effects of mandated use?

Patient Knowledge

  • 8 of 9 randomized controlled trials (RCTs; 3 of interactive computers or videodiscs, 3 of videotapes, 3 of brochures or fact sheets) found greater knowledge among users of informatics tools. (An RCT of an audiotape was not statistically significant.)

Research Question:

  1. What types of tools are most effective for what types of patients?

Patient Attitudes

  • 2 of 3 RCTs (1 of a videotape, 1 of 2 RCTs of interactive videodiscs) and 5 studies without controls found that patients using tools were more satisfied with the decisionmaking process.
  • 1 RCT of an audiotape found a reduction in decisional conflict.
  • 1 RCT of a computer tool found increased confidence in their ability to continue use of oral contraceptives.
  • 4 RCTs of printed tools found no effects on anxiety.

Research Question:

  1. What are the effects of tools on patient attitudes?

Patient-Clinician Communication

  • In 1 RCT, patients given a fact sheet reported asking physicians more questions.

Research Question:

  1. How do tools affect communication and demands on clinician or staff time?

Treatment Selection

  • Adult immunization: 2 RCTs (1 of a brochure, 1 of a computerized decision aid) found tool use increased vaccination rates.
  • Prostate cancer and benign prostatic hyperplasia (BPH):
    • A cohort study found use of a video tool decreased screening.
    • A cohort study of an interactive videodisc in 2 health maintenance organizations (HMOs) found decreases in BPH surgery. (An RCT of this videodisc did not yield statistically significant differences.)
  • Ischemic heart disease: 1 RCT found patients who used an interactive videodisc were less likely to select revascularization surgery.
  • Other conditions: RCTs found no effect of informatics tools on treatment selection in four conditions: an audiotape on hormone replacement therapy, a computer aid for oral contraceptives, a video for vasectomy, and print aids for circumcision. No RCTs on other conditions have been completed.

Research Questions:

  1. What are effects on a wider number of treatment choices?
  2. What factors influence effects on treatment choice?

Health Outcomes and Behavior

  • 1 RCT of an interactive computer aid found higher continued use of oral contraceptives among young low-income, but not other, women.
  • 1 RCT found lower hospitalization among HIV/AIDS patients given a computer system providing information and a decision aid along with a computer-based discussion group.
  • 1 RCT of an interactive videodisc BPH tool found higher patient ratings of general health and physical functioning (but no difference in urinary functioning).

Research Question:

  1. What are effects on health outcomes and behaviors for different types of patients?

Cost Effectiveness

  • 1 RCT found lower hospitalization costs among HIV/AIDS patients given a computer system providing information and a decision aid along with a computer-based discussion group.

Research Question:

  1. What is the cost-effectiveness of different types of tools?

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