Development of a patient decision aid on inhaled corticosteroids use for adults with asthma

Abstract

Background: Patient decision aids (PDAs) are used in shared decision making to improve practitioner-patient communication and help patients decide about treatment options. To develop a PDA for adults with asthma considering inhaled corticosteroids, with or without long-acting beta₂-agonists, to optimize asthma control. Methods: The PDA was developed based on the International Patient Decision Aid Standards. Step 1: PDA was drafted. Step 2: PDA acceptability was assessed among target users, certified asthma educators (CAEs) and adults with asthma, following an iterative process. a) Participants read the PDA, b) rated its presentation, length, balance, and perceived usefulness, indicated what they liked/disliked about it, and made suggestions for improvement. c) Based on results from (b), PDA was refined. This process was repeated with new participants until no suggestions were made. Step 3: The PDA was field tested with target users. Interviews with CAEs were conducted to identify areas of improvement. Step 4: Final PDA version was written. Results: A color-printed, 4-page, letter-sized PDA was drafted. Acceptability testing involved 11 CAEs (women, n = 10) and 20 adults with asthma (women, n = 13; age 22–61 years). Five successive refined versions were produced. Major changes were made to PDA terminology, instructions, paper size, and visual presentation. Two CAEs (women, n = 2) and 26 adults with asthma (women, n = 19; age 20–65 years) field tested PDA. Minor changes were made to language and instructions to ensure usability. The final version was a color-printed, 12-page, A3-sized booklet. Conclusion: Our newly developed PDA was found acceptable and usable in target users.

Keywords:

• Asthma
• decision support
• inhaled corticosteroids
• inhaled controller medication
• respiratory disease
• shared decision making

Acknowledgements

The authors acknowledge Marie-Ève Boulay, MSc, Philippe Prince, MSc, Françoise Proust, PhD, and Julie Turmel, PhD, for assistance in writing the study protocol and/or revising the manuscript. The authors thank Greg Kelm for translating the quotations from French to English, and Erica Pridoehl, MEd, for editing the English manuscript. The authors are grateful to Patricia Côté, MA, and France Rigali for bringing us into contact with certified asthma educators and wish to thank Francine Deschesnes, Claudine Ferland, Johane Lepage, Joanne Milot and Hélène Villeneuve for help in recruitment of adults with asthma. The authors are very grateful to clinicians who provided access to patients and, last but not least, to the individuals who gave up their time to participate in the study.

Declaration of interest

Potential conflicts of interest to disclose are: 1) the Laval University Chair on Knowledge Translation, Prevention and Education in Respiratory and Cardiovascular Health is supported by unrestricted grants from AstraZeneca, and 2) the Chair on Adherence to Treatments was supported by unrestricted grants from AstraZeneca, Merck Canada, Sanofi Canada, Pfizer Canada and the Prends soin de toi program. MG, FL, and JM have no conflict of interest to declare. LPB considers having no conflict of interest but wishes to declare what can be perceived as “potential” conflicts of interest. Advisory Boards: GlaxoSmithKline, Novartis. Conferences (honoraria): AstraZeneca, GlaxoSmithKline, Merck, Novartis. Sponsorship for investigator-generated research: AstraZeneca, GlaxoSmithKline, Merck Frosst, Schering. Sponsorship for research funding for participating in multicenter studies: AllerGen, Altair, Amgen, Asmacure, AstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Novartis, Ono Pharma, Pharmaxis, Schering, Wyeth. Support for the production of educational materials: AstraZeneca, GlaxoSmithKline, Merck Frosst, Boehringer-Ingelheim, Novartis. Organizational: Chair of the Global Initiative for Asthma (GINA) Guidelines Dissemination and Implementation Committee, Laval University Chair on Knowledge Translation, Prevention and Education in Respiratory and Cardiovascular Health, Member of the Executive Committee of InterAsma (Global Asthma Organisation). The authors alone are responsible for the content and writing of this article.

Funding

Financial support has been provided by AllerGen NCE Inc.