0568 Promoting Shared Decision Making with a Novel Self-Monitoring Program for Veterans with Obstructive Sleep Apnea

Abstract Introduction Optimal shared decision making (SDM) occurs when patients are well-informed about their treatment options and, with clinician collaboration, can determine the best care for their well-being. Data pertaining to treatment success guide future decisions on care management, such as the decision to continue with current therapy versus transitioning to alternate therapies. Unfortunately, patients with obstructive sleep apnea (OSA) on non-positive airway pressure (non-PAP) treatments (e.g., dental devices) often lack night-to-night data supporting therapy effectiveness. We designed a self-monitoring program that provides night-to-night data for Veterans on non-PAP OSA treatment, with the goal of promoting SDM. Methods Patients with OSA prescribed non-PAP treatment from a VA sleep center were invited to participate in a quality improvement project for 1, 2, or 4 weeks, depending on project phase. A consumer-grade smartwatch was provided to each patient to collect pulse oximetry (SpO2) data while sleeping. Patients completed a weekly survey on their daytime sleepiness, mood, daily functioning, and use of non-PAP treatment. A report with their survey responses and SpO2 data was sent to patients weekly. A sleep clinician met with patients to discuss the report and OSA treatment. We assessed SDM with CollaboRATE-5 (3-items, score range 0-12, 0=no effort was made, 12=every effort was made). We conducted post-program semi-structured interviews with patients and analyzed interview data using content analysis to infer themes and/or meanings of SDM. Results Out of 11 veterans enrolled in the program (1 9.1% female, mean age 54, 7 63.6% non-white or multiracial), 9 (81.8%) have completed the program. Qualitative analysis revealed 3 themes related to SDM: 1) Information provision; 2) Patient preference elicitation; and 3) Patient preference integration. Four of 9 participants mentioned that they would reconsider PAP therapy at the conclusion of the program. A mean CollaboraRATE score of 7.1 (SD=3.0) indicates that respondents felt the program made some effort to address their concerns and integrated their preferences in OSA treatment. Conclusion Implementing a self-monitoring program as part of OSA treatment has promoted SDM with nearly half of patients expressing an interest to retry or consider PAP treatment. Support (if any) VA Office of Connected Care