Right choice, right time: Evaluation of an online decision aid for youth depression.

Abstract

<h4>Background</h4>Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this.<h4>Objectives</h4>The main objective of this study was to evaluate an online decision aid for youth depression.<h4>Design</h4>An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements.<h4>Setting and participants</h4>Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services.<h4>Intervention</h4>Online decision aid with evidence communication, preference elicitation and decision support components.<h4>Main outcome measures</h4>The main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow-up.<h4>Results</h4>After using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3-22.9 points lower) on the Decisional Conflict Scale (range 0-100)) and felt involved and satisfied with their decision. At follow-up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3-4.0 points lower) on the Patient Health Questionnaire nine-item scale (range 0-27)) and were adherent to 88% (95% CI: 82%-94%) of treatment courses.<h4>Discussion and conclusions</h4>A decision aid for youth depression can help ensure evidence-based, client-centred care, promoting collaboration in this often difficult to engage population.