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# DECIDE (shared DECIsion in hEalth): a three steps user-centered design.

Élodie Charuel

► To cite this version:

Élodie Charuel. DECIDE (shared DECIsion in hEalth): a three steps user-centered design.. 27e Journée scientifique de l'Ecole Doctorale Sciences de la Vie, Santé, Agronomie, Environnement, ED SVSAE, Jun 2024, Clermont-Ferrand, France. hal-04958766

HAL Id: hal-04958766

https://hal.science/hal-04958766v1

Submitted on 20 Feb 2025

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Distributed under a Creative Commons Attribution 4.0 International License
DECIdE
shared DECIsion in hEalth

a three steps user-centered design

Elodie CHARUEL, Médecin Généraliste, Doctorante à l'ED SVSAE, UR ACCePPT, UCA
Cheffe de Clinique des Université, Département Médecine Générale

Directeurs de thèse : Pr Hélène VAILLANT-ROUSSEL et Pr Philippe VORILHON

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DÉCISION PARTAGÉE
EN SANTÉ

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UNIVERSITÉ
Clermont
Auvergne

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ISDM
SOCIÉTÉ

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ISDM 2024

12th International Shared Decision Making Conference

Coproduction: Harnessing the power of partnerships

Lausanne, Switzerland

July 7 - 10 2024

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unisanté
# Disclosure of potential conflicts of interest.

No conflict of interest

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DÉCISION PARTAGÉE
EN SANTÉ

Elodie CHARUEL, Médecin Généraliste, Doctorante à l'ED SVSAE, UR ACCePPT, UCA Cheffe de Clinique des Université, Département Médecine Générale

Directeurs de thèse : Pr Hélène VAILLANT-ROUSSEL et Pr Philippe VORILHON

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UNIVERSITÉ
Clermont
Auvergne

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ISDM
SOCIÉTÉ

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## ISDM 2024

12th International Shared Decision Making Conference

Coproduction: Harnessing the power of partnerships

Lausanne, Switzerland

July 7 - 10 2024

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unisanté
Context

Optional prescription drugs

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65%

1,8M €

Patient
values and
expectations

EBM

Clinical
expertise

Research
evidences

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HAS

HAUTE AUTORITÉ DE SANTÉ
Aim

To develop a decision aid

for general practitioners (GPs)
and community pharmacists (CPs)

about optional prescription drugs

in a user-centered approach.

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# Methods

## Step 1

### Nominal group

* GPs, CPs from the field and expert patients

* To determine tool's specifications

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## Step 2

### User testing

* Simulated consultations

* Individual interviews / clinical psychologists

* To improve the prototype

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## Step 3

### Experts consensus

* eDELPHI methods

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* To obtain an academic validation according to IPDAS criteria
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Step 1 : nominal group consensus

<table><thead><tr><th></th><th>General Practitionners</th><th>Community pharmacists</th><th>Expert Patients</th><th>TOTAL</th></tr></thead><tbody><tr><th>n</th><td>6</td><td>6</td><td>4</td><td>16</td></tr><tr><th>Men</th><td>4</td><td>2</td><td>2</td><td>8</td></tr><tr><th>Women</th><td>2</td><td>4</td><td>3</td><td>8</td></tr><tr><th>University</th><td>6</td><td>5</td><td>0</td><td>11</td></tr><tr><th>From the field</th><td>6</td><td>6</td><td></td><td>12</td></tr><tr><th>Shared decision expert</th><td>3</td><td>0</td><td></td><td>3</td></tr></tbody></table>

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BÉNÉFICES

SYMPTÔMES

- Brûlures d'estomac
- Remontées ou renvois acides (pyrosis)
- Aigreurs d'estomac

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RISQUES

Amélioration du symptôme de reflux acide

Comprimé à croquer
Risque relatif : 1,45

PLACEBO

MÉDICAMENT

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Preuve solide

Diminution du nombre de reflux

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Individuals answers to one question :

What are the elements or characteristics (content and form) that should make up decision aid for GPs/CPs and patients concerning a medicine?

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Discussion meeting

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Vote for consensus on specifications

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Step 2 : users-testing

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Step 3 : experts consensus validation

14 french-speaking experts in decision aids and shared
decision making
4 countries

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<table><thead><tr><th></th><th>Medical doctor</th><th>Pharmacists</th><th>Researchers<br>Non-healthcare<br>professionnal</th><th>TOTAL</th></tr></thead><tbody><tr><th>n</th><td>11</td><td>2</td><td>1</td><td>14</td></tr><tr><th>Men</th><td>9</td><td>1</td><td>0</td><td>10</td></tr><tr><th>Women</th><td>2</td><td>1</td><td>1</td><td>4</td></tr></tbody></table>

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2 rounds
about 13 proposals inspired by IPDAS criterias
To validate DECIdE as a decision aid

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Final tool

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SYMPTÔMES_

- Brûlures d'estomac

- Remontées ou renvois acides

- Aigreurs d'estomac

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Discussion: strength and limitations

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- User-center conception involving patients

- Rigorous application of mixed consensus methods (nominal group and eDELPHI)

- Interprofessional collaboration (GPs, CPs, clinician psychologists, economist, researchers...)

- Potential selection bias of the patients in user-tests

- Unbalanced experts group : lack of expert in shared decision among pharmacists

- Incomplete consensus on the proposed IPDAS criteria « *The presentation of the expected beneficial and undesirable effects allows the patient to imagine the psychological impact of taking the drug.* »
# Discussion : comparison to litterature

## Usable tool ?

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Lengthening of **consultation times** is one of the main obstacles identified by healthcare professionals (Legare et al. 2008) => average consultation time with DECIdE : 8min

« When patient decision aids were used during the consultation with the clinician, the length of consultation was **1.5 minutes longer** (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants) » (Stacey et al. 2024)

## Communication of benefits and risks

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« Visual aids (icon arrays and bar graphs) improved patients' understanding (...). Presentations including absolute risk reductions were better than those including relative risk reductions for maximizing accuracy » (Zipkin et al., 2014)
# Discussion : comparison to litterature

## Patients involvement

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⇒ focus groups and patient user-tests (Williams et al., 2021)

=> 50 % of patient decision aid projects reported involving users in at least 1 step for understanding users, 35% in at least 1 step for developing/refining the prototype, and 84% in at least 1 step for observing users' interaction with the prototype (Vaisson et al. 2021)
Perspectives

A real-life cluster randomised controlled trial is currently being conducted to study the impact of DECIdE on decisional conflict, in Auvergne Rhone-Alpes area.

The DECIdE website will be available to all professionals wishing to share their decision on medication with their patients.

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Thank you for
your attention

To contact me about DECIdE project : elodie.charuel@uca.fr

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DÉCISION PARTAGÉE
EN SANTÉ

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UNIVERSITÉ
Clermont
Auvergne

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ISDM
SOCIETY

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ISDM 2024
12th International Shared Decision Making Conference
Coproduction: Harnessing the power of partnerships

Lausanne, Switzerland
July 7 - 10 2024

<figure><img src="image_54.png" /></figure>

unisanté