A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study.
Thomas J Reese, Guilherme Del Fiol, Keaton Morgan, Jason T Hurwitz, Kensaku Kawamoto, Ainhoa Gomez-Lumbreras, Mary L Brown, Henrik Thiess, Sara R Vazquez, Scott D Nelson, Richard Boyce, Daniel Malone
Author Information
Thomas J Reese: Vanderbilt University, Nashville, TN, United States. ORCID
Guilherme Del Fiol: University of Utah, Salt Lake City, UT, United States. ORCID
Keaton Morgan: University of Utah, Salt Lake City, UT, United States. ORCID
Jason T Hurwitz: University of Arizona, Tuscon, AZ, United States. ORCID
Kensaku Kawamoto: University of Utah, Salt Lake City, UT, United States. ORCID
Ainhoa Gomez-Lumbreras: University of Utah, Salt Lake City, UT, United States. ORCID
Mary L Brown: University of Arizona, Tuscon, AZ, United States. ORCID
Henrik Thiess: University of Heidelberg, Heidelberg, Germany. ORCID
Sara R Vazquez: University of Utah, Salt Lake City, UT, United States. ORCID
Scott D Nelson: Vanderbilt University, Nashville, TN, United States. ORCID
Richard Boyce: Department of Biomedical Informatics, University of Pittsburgh, Pittsburg, PA, United States. ORCID
Daniel Malone: University of Utah, Salt Lake City, UT, United States. ORCID
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.
