Video‐Based Decision Aids Improve Sleep Surgery Decision‐Making: A Randomized Controlled Trial

Abstract

ObjectivesDecisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre‐consultation video decision aids on patient DC and decision readiness.MethodsPrior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]–100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as “high‐conflict.” Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement.ResultsTwenty‐five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post‐visit improvements in DC scores (post‐consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision‐making stage after the visit, with 72.7% “close to selecting an option” (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High‐conflict patients (n = 5) who reviewed pre‐visit videos (intervention sub‐group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high‐conflict control patients.ConclusionsPatients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision‐making process.Level of Evidence2 Laryngoscope, 2023