The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers
DOI: 10.1186/s40621-021-00310-4
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Summary
This paper outlines the design and methods of the Advancing Understanding of Transportation Options (AUTO) study, a multi-center randomized controlled trial addressing the complex decision-making process surrounding driving cessation in older adults. The research is motivated by the dual challenges of increased crash risk among drivers aged 75 and older and the negative health impacts associated with driving cessation, such as loss of independence and mental well-being. While decision aids are known to improve decision quality in other healthcare contexts, their effectiveness for older drivers has not been previously tested in a randomized trial. The study aims to determine if a web-based decision aid improves the quality of decisions regarding driving behaviors and mitigates negative psychosocial outcomes. The AUTO study is a two-armed randomized controlled trial enrolling 300 dyads, consisting of drivers aged 70 or older and a designated study partner (family member or friend). Recruitment occurs at primary care clinics in California, Colorado, and Indiana. Participants are stratified by site and randomized 1:1 into an intervention group or a control group. The intervention group utilizes a web-based decision aid developed by Healthwise, which provides evidence-based information on risks and benefits, facilitates values clarification, and includes personal stories. The control group accesses the National Institute on Aging’s “Older Drivers” website, which offers general information but lacks structured decision-support elements. Both groups navigate the materials at their own pace. Data collection occurs at baseline, 6, 12, 18, and 24 months, with assessments conducted via telephone or in-person visits. The primary outcome is immediate decision quality, measured by the Decisional Conflict Scale, where lower scores indicate higher clarity and alignment with personal values. Secondary outcomes include longitudinal psychosocial measures (depressive symptoms, decision regret, and life-space mobility) and driving behaviors (frequency, avoidance, and cessation) assessed at 12 and 24 months. The study also evaluates knowledge, decision self-efficacy, cognitive function, and decisional capacity. Planned stratified analyses will examine the intervention’s effects in subgroups defined by cognitive status, decisional capacity, and readiness to stop driving. The study protocol includes rigorous safety monitoring, including procedures for identifying potentially impaired drivers who may require professional evaluation. As the first large-scale randomized trial of a driving decision aid for older adults, the AUTO study holds significant implications for clinical practice. By evaluating whether structured decision support improves decision quality and reduces negative psychosocial impacts, the findings will inform how healthcare providers and families can best support older adults in navigating the transition away from driving. The study’s focus on dyadic participation and specific subpopulations, such as those with cognitive impairment, addresses critical gaps in understanding how to manage driving retirement safely and effectively.
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The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed. Discovered via author_sweep_intake on 2026-05-27 (2 acquisition events logged).
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | author_sweep | — | — | 3 | 2026-05-28 |
| archive | success | canonical_url | — | — | 1 | 2026-06-06 |
| extract | success | cached | — | — | 3 | 2026-06-15 |
| clean | success | clean | — | — | 1 | 2026-06-04 |
| chunk | success | chunk | — | — | 1 | 2026-06-04 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-04 |
| enrich | skipped | — | — | — | 3 | 2026-06-04 |
| promote | success | — | — | — | 1 | 2026-06-04 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 2 | 2026-06-15 |
| tag | success | vector_similarity | — | — | 15 | 2026-06-11 |
| verify | success | — | — | — | 1 | 2026-06-15 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-15; verification: verified.
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