Effects of a smartphone application named Shared Decision Making Assistant for informed patients with primary liver cancer in decision-making in China: a quasi-experimental study

Background It is well known that decision aids can promote patients' participation in decision-making, increase patients' decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a Shared Decision Making Assistant smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China. Methods In this quasi-experimental study , 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the Shared Decision Making Assistant application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann-Whitney tests. Results Informed PLC patients in the intervention group (SDM Assistant group) had significantly lower decision conflict scores than those in the control group. (SDM Assistant group: 16.89 +/- 8.80 vs. control group: 26.75 +/- 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 +/- 8.16), decision self-efficacy score (87.75 +/- 6.87), decision satisfaction score (25.68 +/- 2.10) and knowledge of PLC treatment score (14.52 +/- 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of regret of decision making between the two groups had no statistical significance after 3 months (P > 0.05). Conclusions Access to the Shared Decision Making Assistant enhanced the PLC patients' performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the Shared Decision Making Assistant in clinical employment and future studies.

Automated summary

The results of the study show that the Shared Decision Making Assistant application can help reduce decision conflict, increase decision preparation and self-efficacy, enhance knowledge of PLC treatment, and improve satisfaction among patients with PLC. Therefore, promoting and updating the Shared Decision Making Assistant in clinical practice and future research is recommended.