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. 2021 Oct 26;8(4):e28618.
doi: 10.2196/28618.

A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study

Thomas J Reese  1 , Guilherme Del Fiol  2 , Keaton Morgan  2 , Jason T Hurwitz  3 , Kensaku Kawamoto  2 , Ainhoa Gomez-Lumbreras  2 , Mary L Brown  3 , Henrik Thiess  4 , Sara R Vazquez  2 , Scott D Nelson  1 , Richard Boyce  5 , Daniel Malone  2
Affiliations

A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study

Thomas J Reese et al. JMIR Hum Factors. .

Abstract

Background: Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric.

Objective: This study aims to design and study the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.

Methods: We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract-an SDM electronic health record app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale.

Results: The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. A total of 4 patients and 11 clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean of 144 (SD 74) seconds and rated the usability of DDInteract as 4.32 (SD 0.52) of 5.

Conclusions: This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology.

Keywords: clinical decision support; drug interaction; shared decision-making; user-centered design.

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Conflict of interest statement

Conflicts of Interest: This study was funded by the Agency for Healthcare Research and Quality (U18 PA-18-792 and R18HS026198). Outside of the described work, KK reports honoraria, consulting, sponsored research, licensing, or codevelopment in the past 3 years with McKesson InterQual, Hitachi, Pfizer, Premier, Klesis Healthcare, RTI International, Mayo Clinic, the University of Washington, the University of California at San Francisco, MD Aware, and the US Office of the National Coordinator for Health IT (via ESAC and Security Risk Solutions) in the area of health information technology. KK was also an unpaid board member of the nonprofit Health Level Seven International health information technology standard development organization, he is an unpaid member of the US Health Information Technology Advisory Committee, and he has helped develop a number of health information technology tools outside of the described work, which may be commercialized to enable wider impact. None of these relationships have direct relevance to the paper but are reported in the interest of full disclosure. Other authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Summary of the design and usability process for DDInteract. IPDAS: International Patient Decision Aid Standards Collaboration.
Figure 2
Figure 2
Icon array evolution, from left to right, through two iterations. NSAID: nonsteroidal anti-inflammatory drug.
Figure 3
Figure 3
Stable prototype used for heuristic evaluation. Numbers refer to items described in the heuristic report. GI: gastrointestinal.
Figure 4
Figure 4
Final DDInteract high-fidelity prototype used in the usability study along with feature description. NSAID: nonsteroidal anti-inflammatory drug.
See this image and copyright information in PMC

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