• Roberto Abadie, Audrey J Weymiller, Jon Tilburt, Nilay D Shah, Cathy Charles, Amiram Gafni, and Victor M Montori.
• Health Sciences Doctoral Programs, Public Health, Graduate Center, City University of New York, NY, USA.
• J Eval Clin Pract. 2009 Jun 1; 15 (3): 492497492-7.

ObjectiveTo describe how clinicians use decision aids.BackgroundA 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters.DesignTwo researchers working independently and in duplicate reviewed and coded the 22 encounter videos.Setting And ParticipantsTwenty-two patients with diabetes (57% of them on statins) and six endocrinologists working in a referral diabetes clinic randomly assigned to use the decision aid during the consultation.Main Outcome MeasuresProportion and nature of unintended use of the Statin Choice decision aid.ResultsWe found eight encounters involving six clinicians who did not use the decision aid as intended either by not using it at all (n = 5; one clinician did use the decision aid in three encounters), offering inaccurate quantitative and probabilistic information about the risks and benefits of statins (n = 2), or using the decision aid to advance the agenda that all patients with diabetes should take statin (n = 1). Clinicians used the decision aid as intended in all other encounters.ConclusionsUnintended decision aid use in the context of videotaped encounters in a practical randomized trial was common. These instances offer insights to researchers seeking to design and implement effective decision aids for use during the clinical visit, particularly when clinicians may prefer to proceed in ways that the decision aid apparently contradicts.

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