“Is it time to stop driving?”: A randomized clinical trial of an online decision aid for older drivers
DOI: 10.1111/jgs.17791
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Summary
This randomized clinical trial, part of the Advancing Understanding of Transportation Options (AUTO) study, evaluated the efficacy of an online driving decision aid (DDA) for older adults. The research addresses the complex and often stressful decision older drivers face regarding when to cease driving, a transition linked to health and psychosocial well-being. While decision aids are common in clinical medicine, their effectiveness for driving cessation had not been previously tested. The study aimed to determine if the Healthwise® DDA could improve decision quality, defined by reduced decision conflict, increased knowledge, and enhanced self-efficacy. The study enrolled 301 English-speaking licensed drivers aged 70 or older across three US sites (California, Colorado, and Indiana). Participants were required to have at least one diagnosis associated with increased risk of driving cessation (e.g., macular degeneration, Parkinson disease) but no significant cognitive impairment (Montreal Cognitive Assessment score ≥21). Participants were randomized 1:1 to either the intervention group, which accessed the interactive Healthwise® DDA, or the control group, which viewed general informational content from the National Institute on Aging website. The primary outcome was decision conflict measured by the Decisional Conflict Scale (DCS) immediately after exposure. Secondary outcomes included knowledge scores and decision self-efficacy. Analyses used generalized linear mixed-effects models adjusted for site and pre-randomization scores. Results indicated that the DDA significantly improved decision quality metrics. Participants in the intervention group had a lower mean DCS score (12.3) compared to the control group (15.2), representing a 24% reduction in decision conflict (adjusted mean ratio 0.76; p=0.017). The intervention group also demonstrated significantly higher knowledge scores (88.9 vs. 79.9; p=0.038). However, there was no significant difference in self-efficacy scores between the groups. The DDA was highly acceptable, with 86.9% of users indicating they would recommend it to others. Notably, despite the intervention, most participants chose to continue driving, and baseline decision conflict was already low across both groups. The findings suggest that online decision aids can effectively reduce decision conflict and increase knowledge among older drivers facing potential driving cessation. This supports the integration of such tools into clinical and community settings to help older adults navigate mobility transitions with greater autonomy and less distress. The authors note limitations, including the predominantly White, urban, and highly educated sample, which may limit generalizability to rural or lower-socioeconomic populations. Future longitudinal analyses from the AUTO study will assess whether these immediate improvements in decision quality translate to long-term psychosocial benefits and changes in driving behavior.
Key finding
Use of an online driving decision aid significantly reduced decision conflict and increased knowledge about driving cessation among older adults compared to standard web-based information.
Methodology
lab_experiment
Sample size: 301
Provenance
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 (3 acquisition events logged).
| Stage | Outcome | Tool | Model | Prompt | Attempts | Completed |
|---|---|---|---|---|---|---|
| discover | success | author_sweep | — | — | 4 | 2026-05-28 |
| archive | success | unpaywall | — | — | 2 | 2026-06-06 |
| extract | success | cached | — | — | 3 | 2026-06-10 |
| clean | success | clean | — | — | 1 | 2026-06-07 |
| chunk | success | chunk | — | — | 1 | 2026-06-07 |
| embed | success | embed | Qwen/Qwen3-Embedding-8B | — | 1 | 2026-06-07 |
| enrich | skipped | — | — | — | 3 | 2026-06-04 |
| promote | success | — | — | — | 1 | 2026-06-04 |
| summarize | success | llm | qwen3.6-27b-prismaquant | summ-v5 | 2 | 2026-06-10 |
| tag | success | vector_similarity | — | — | 15 | 2026-06-11 |
| verify | success | — | — | — | 2 | 2026-06-10 |
Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.
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- Methodological Resource: tool software, validation psychometrics
- Theoretical Contribution: computational model