An electronic patient decision aid comparing as-needed budesonide-formoterol combination to regular use of inhaled corticosteroid (ICS) in mild asthma: a rapid-cycle design study

Background: In mild asthma, evidence suggests that as-needed budesonide-formoterol is equivalent to regular ICS for avoidance of severe asthma exacerbations; yet it comes at a cost of slightly increased asthma symptoms. To guide discussions about these pros and cons, we aimed to develop an electronic decision aid while identifying and integrating user preferences. Methods: We designed a prototype for an electronic 7-step decision aid (meeting International Patient Decision Aid Standards) and comparing as-needed budesonide-formoterol and regular ICS on differences in steroid exposure, symptoms, exacerbations, and costs. This prototype was adapted according to pre-set criteria for critical issues after each rapid-cycle round (consisting of a focus group with 3-5 asthma patients and a primary care doctor interview). This process continued until no new critical issue emerged. Summative content analysis was performed to describe user preferences. Results: Overall, we recruited 21 asthma patients (12/21 women; 10/21 aged ≥60 years; 12/21 holding a University degree) and 5 primary care doctors. Modifications to the content and format of the decision aid were made, to match user preferences for a shorter, lower reading grade-level, and easily accessible tool. A one-pager conversation aid was also created, to summarize, help visualize, and enable timely outcome comparisons during routine appointments. Conclusions: We have integrated user preferences for content and format into a tailored patient decision aid and shorter conversation aid for mild asthma. To drive uptake, these tools will be made available online.