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

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Article numbere28618
JournalJMIR Human Factors
Issue number4
StatePublished - Oct 2021


  • Clinical decision support
  • Drug interaction
  • Shared decision-making
  • User-centered design

ASJC Scopus subject areas

  • Health Informatics
  • Human Factors and Ergonomics


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