Field Testing of a Decision Support Tool for Acute Appendicitis using an Online Randomized Experimental Design

Abstract Background Mounting evidence from randomized controlled trials have shown that antibiotics can be a safe and effective treatment for appendicitis. Patients and surgeons must work together to choose the optimal treatment approach for each patient based on their own preferences and values. We developed a novel decision support tool (DST) to facilitate shared decision making for appendicitis. The effect of this DST on decisional outcomes remains unknown. Methods We conducted an online randomized field test in at-risk individuals comparing the DST to a standard infographic as a control. Individuals were randomized 3:1 to the DST (intervention) or infographic (control). The primary outcome was the total decisional conflict scale (DCS) score measured before and after exposure to the DST. Secondary outcomes included between-group DCS scores, and between group comparisons of the acceptability of DST or infographic. Results 180 individuals were included in the study after quality control checks. Total DCS scores decreased significantly after viewing the DST (59.0 to 14.6, p<0.001) representing movement from a state of high to low decisional conflict. Individuals exposed to the DST reported higher acceptability ratings (3.7 vs. 3.3, p<0.001) and had more individuals who would completely agreed that they would be willing to try antibiotics (45% vs. 21%, p=0.008). Conclusions The novel appendicitis DST significantly decreased decisional conflict in this online randomized field test. Users rated the tool as highly acceptable and expressed increased willingness to consider antibiotics as a treatment approach after viewing it. Study Funding This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases [grant number T32DK070555]; and a generous gift from Marty and Linda Ellison. The development of aspects of the decision support tool was funded by the Patient Centered Outcomes Research Institute. The funding sources had no role in the study design, collection, analysis, or interpretation of data, in the writing of the manuscript or in the decision to submit for publication.