Discussion
anxiety
SECONDARY
In this RCT of an LCS PDA, contrary to our hypothesis, we found no statistically significant difference in our primary outcome of decisional conflict between the LCSDecTool and control groups at 1 month after intervention. However, LCS knowledge increased immediately after intervention and remained higher over time, and LCS uptake was higher in the LCSDecTool group (37.7% vs 21.1%). There was no difference in decisional regret or general anxiety between groups.The trajectory of decisional conflict in our study indicates a lower level of decisional conflict in the LCSDecTool group vs the control group immediately after intervention, with differences mitigated at 1 and 3 months. Decisional conflict may be most subject to change immediately following use of a PDA due to the salience of new information and value clarification experience. However, some users may continue to process information and weigh risks and benefits over a period of time; measurement of decisional conflict at 1 month may reflect the results of this process.The persistent increase in LCS knowledge among the LCSDecTool group vs the control group indicates effective communication of concepts relevant to LCS, including the potential benefits and harms. The higher uptake of LCS among the LCSDecTool group could reflect increased awareness of LCS, greater knowledge about LCS benefits and harms, and an individual value assessment that the benefits outweighed the harms. Participants also had the opportunity to discuss LCS with clinicians, as the intervention was timed to coincide with a scheduled clinic visit. Although both interventions provided participants with LCS guidelines, the LCSDecTool, which was designed to facilitate an informed and value-aligned decision process, may have worked through those mechanisms.Shared decision-making for LCS is widely recommended by professional organizations, guideline committees, and payers.In a cluster randomized trial among 8 VA Medical Centers, Lowery et alOur study has clinical and research implications. Our findings support the use of a PDA in the setting of a primary care clinic visit when a discussion can occur and a decision about LCS can be made. In addition, the secondary findings of increased uptake of LCS combined with a sustained increase in knowledge about LCS benefits and harms support the value of the LCSDecTool. Further studies are needed to elucidate the trajectory of decision quality outcomes and LCS uptake over time following the use of a PDA.