Evaluation of the Impact of Decision Aids on Treatment Choices in Patients With Arterial Hypertension: A Pilot Study

Detailed Description

1. INTRODUCTION Arterial hypertension is one of the most important modifiable risk factors for cardiovascular disease and a leading cause of premature death worldwide. Despite effective therapies, only about 20% of the 1.28 billion adults worldwide have their blood pressure under control, increasing the risk of major cardiovascular events. This highlights the need for personalized treatment strategies and patient engagement. Shared decision-making (SDM) is a key approach to collaborative decision-making between patients and healthcare professionals, aimed at tailoring treatment options and goals to patients' needs and preferences, as emphasized in the ESC 2024 guidelines. Patient decision aids (PDAs) are tools designed to support SDM by providing clear information about treatment options, risks and benefits, while helping patients to clarify their preferences and values. Evidence suggests that PDAs improve the quality of decisions, promote adherence and have a positive impact on hypertension outcomes.
2. BACKGROUND AND RATIONALE Hypertension management requires a patient-centered approach, as treatment goals, such as achieving a target systolic blood pressure of 120-129 mmHg, should be adapted to individual tolerance and well-being. The 2024 ESC guidelines highlight the importance of SDM. PDAs can help overcome challenges. These tools prepare patients to make value-based decisions without replacing medical consultations. Despite their potential benefits, there is limited evidence on which PDA format and features are most effective for hypertensive patients. This pilot study aims to address this gap by evaluating different PDA formats to identify those that best improve patient understanding, knowledge and value clarification. The results will inform the design of optimized PDAs for clinical use in hypertension management and contribute to overcoming existing barriers to SDM in practice.
3. OBJECTIVES The aim of this pilot study is to evaluate PDAs for antihypertensive therapy from the patient's perspective to answer the following research question: Which format of PDA is most useful in practice to support SDM in hypertension management?

Specifically, the study aims to:

1. Evaluate which design features of two different PDA formats are most effective improving patients knowledge of hypertension management regarding the available treatment options, including their benefits and risks.
2. Evaluate how PDAs support patients in clarifying their personal values and preferences regarding treatment choices.
3. Investigate whether the use of PDAs increases patients involvement in SDM. Findings will inform the development of optimized PDA formats that can improve patient adherence, enhance decision quality, and ultimately contribute to better clinical outcomes in hypertension care.
4. METHODS Study design: Randomized controlled pilot study to assess which format of PDAs is most useful in supporting SDM about antihypertensive therapy and to identify potential challenges and refine the methodology for a future large-scale trial. Participants: the study will include a minimum of 60 adult patients (≥ 18 years) diagnosed with arterial hypertension of any grade and regardless of the time of diagnosis. Patients need to be treated at the Department of Internal Medicine I, University Hospital Brandenburg an der Havel, Germany. Eligible participants will be invited to participate regardless of their reason for hospitalization, provided they meet the inclusion criteria. Randomization: Participants will be randomly allocated to one of two intervention arms using a computer-generated allocation sequence. Intervention arm A:

Participants will use the decision aid "How so I control my blood pressure? Lifestyle options and choices of medicines." (https://www.nice.org.uk/guidance/ng136/resources/how-do-i-control-my-blood-pressure-lifestyle-options-and-choice-of-medicines-patient-decision-aid-pdf-6899918221) Intervention arm B: Participants will use the decision aid "Bluthochdruck - Wie Herz-Kreislauf-Erkrankungen vorbeugen?" (engl.: High Blood Pressure - How to prevent cardiovascular disease). (https://entscheidungshilfe.share-to-care.de/bluthochdruck/)