From dialogue to decision Using technology to facilitate shared decision-making in a fall prevention context

Falls are a leading cause of traumatic injury among older patients, and medication intake is a big risk factor for falls. General practitioners and older patients should evaluate the patient’s medication usage together regularly while engaging in a shared decision-making conversation. However, this is currently often not done (sufficiently). This dissertation aims to describe the systematic development and evaluation of a technological intervention that can provide personalized decision support to general practitioners and older patients to facilitate shared decision-making regarding the medication-related fall risk.
The intervention consists of a clinical decision support system with a prediction model that calculates individualized fall risks, and a patient portal that helps the patient prepare for the consultation with their general practitioner. The dissertation describes the systematic development of these systems, applying a user-centered design approach in which end users are involved in all phases of the development process. Prototypes were developed based on a systematic literature review, focus groups, and interviews. These prototypes were further improved by conducting usability testing with a think-aloud method.
The dissertation also describes the evaluation of the intervention with a randomized controlled trial. The results are promising. The intervention enhanced shared decision-making, increased patients’ satisfaction with the communication during the consultation, and diminished the level of decisional conflict experienced by patients. The effects on the medication changes made during the consultations seem promising, but for now remain inconclusive and need further exploration. This dissertation has showcased the great potential of innovative technology-driven interventions to empower patients and guide healthcare providers to engage in effective shared decision-making.