Deciding on the location for receiving parenteral antimicrobial therapy: development and preliminary testing of a patient decision aid

BACKGROUND: Adult patients who need further treatment with parenteral antimicrobial therapy after a stay in the emergency department could be involved in the decision about the location of treatment. Although patients often get admitted to hospitals for parenteral antimicrobial therapy, they can also receive it in their home with different support. Therefore, this study aimed to develop and alpha test a patient decision aid to support patient involvement in this decision.

METHODS: A systematic development process was guided by the Ottawa Decision Support Framework. This process included developing a patient decision aid and conducting individual interviews with Danish patients and healthcare professionals to test the comprehensibility, acceptability, and usability of the aid. Directed content analysis guided the analysis.

RESULTS: An in-consult 2-page patient decision aid was developed to fit the busy environment of the emergency department. It included (a) a title specifying the decision; (b) information on the treatment, three options, advantages and disadvantages of the options; (c) a value clarification exercise; and (d) a question about preferred option. The patient decision aid met the qualifying criteria of the International Standards for Decision Aids. Participants’ feedback on the comprehensibility was positive, indicating explicit and clear options, and minor suggestions for editing. The healthcare professionals were reserved when asked about the acceptance and usefulness of the patient decision aid because the three options were not considered equal and were difficult to offer due to limited resources. The patients were also skeptical that their preferences could be considered in the decision-making, and they expressed uncertainty about whether treatment at home was as safe as hospitalization. The healthcare professionals recognized the importance of shared decision-making. However, the implementation of the decision aid would necessitate specific competencies, and identification of the best time to introduce it to patients.

CONCLUSIONS: Using a systematic process, a patient decision aid was developed. Comprehensive findings revealed that the decision aid could be useful in supporting shared decision-making and in clarifying the available options. However, for the decision aid to be implemented, there needs to be a clear context and training of healthcare professionals in shared decision-making.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-025-13434-w.