Randomized Pilot Test of a Decision Support Tool for Acute Appendicitis

Abstract

Objective: To test the effect of a new decision support tool for acute appendicitis and assess its efficacy and acceptability. 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 decision support tool to facilitate shared decision-making for appendicitis and its effect on decisional outcomes remains unknown. Methods: We conducted an online randomized field test in at-risk individuals comparing the decision support tool to a standard infographic. Individuals were randomized 3:1 to view the decision support tool or infographic. The primary outcome was the total decisional conflict scale (DCS) score measured before and after exposure to the decision support tool. Secondary outcomes included between-group DCS scores, and between-group comparisons of the acceptability. Results: One hundred eighty individuals were included in the study. Total DCS scores decreased significantly after viewing the decision support tool (59 [95% confidence interval (CI): 55–63] to 15 [95% CI: 12–17], P < 0.001) representing movement from a state of high to low decisional conflict. Individuals exposed to the decision support tool reported higher acceptability ratings (3.7 [95% CI: 3.6–3.8] vs 3.3 [95% CI: 3.2–3.5] out of 4) and demonstrated increased willingness to consider both treatment options. Conclusions: These data support the further use and testing of this novel decision support tool in patients with acute appendicitis.