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Early Feedback on a Goals-Based Decision Support Aid for Metoidioplasty and Phalloplasty Surgeries (MaPS)
Lee Keating Brown, BA1, Christopher Tirrell, PhD2, Rebecca Butcher, MS, MPH2, Glyn Elwyn, MD, PhD, MSc3, Rachel A. Moses, MD, MPH1.
1Geisel School of Medicine at Dartmouth, Hanover, NH, USA, 2The Center for Program Design and Evaluation (CPDE), The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA, 3The Coproduction Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA.
BACKGROUND: Patients considering metoidioplasty and/or phalloplasty surgeries (MaPS) have decisional conflict. We are co-developing a web-based decision aid (DA) to promote shared decision making (SDM) through individual goal clarification and education to prepare patients for their surgical consultation. The purpose of this study was to apply a mixed methods approach to evaluate acceptability and usability of the DA to inform user-centered, iterative revision.
METHODS: Adult patients (n=15) considering MaPS were recruited from a large national sample to provide feedback on the DA via focus groups. Additionally, semi-structured interviews were conducted with providers (n=9) representing multiple specialties (urology, gynecology, endocrinology, and psychiatry). All participants completed an adapted Acceptability E-scale measure and System Usability Scale. Qualitative data were analyzed using thematic analysis. Quantitative data were summarized with descriptive statistics.
RESULTS: A majority of patient and provider ratings of DA acceptability [Figure 1] and usability [Figure 2] were positive. Qualitative themes in patient focus groups included patient preferences for nuanced language over technical impersonal phrasing and outputs that reflect multi-priority decision making. Surgeons noted DA exposure may enable more informed discussions about surgical options during consultations.
CONCLUSIONS: Early stakeholder feedback indicates that implementing the DA in a clinical setting may be feasible and has the potential to enhance SDM. The revised DA will be evaluated to assess effects on patient decisional conflict and decision readiness prior to surgical consultation in a multi-site randomized controlled trial.
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