Article type
Year
Abstract
Introduction:
Objectives: Patient decision aids or "shared decision making programs" provide evidence-based information on health care options and outcomes to prepare patients for decision making with their practitioners. We conducted a Cochrane systematic review to evaluate their effectiveness on decision making and outcomes of decisions.
Methods: A literature search was performed using the MEDLINE, PsycINFO, CINAHL, Aidsline, CancerLit and EMBASE databases. In addition, the CCTR was searched, as well as the personal files of the authors. Inclusion criteria were: published in English; random allocation of interventions; participants older than 14 years and at the point of decision making; and interventions provided information on options and outcomes to support patients' decision making regarding specific treatment or screening choices. Two independent reviewers screened abstracts and extracted data using standardized forms. For continuous outcomes (knowledge, decisional conflict, satisfaction), weighted mean differences were calculated (WMD). For dichotomous outcomes (preference for most intensive option), odds ratios (OR) were calculated using fixed effects models.
Results: The database search yielded 10,387 unique abstracts, of which 500 focused on patient decision making. Eighteen studies met the inclusion criteria. Knowledge scores were significantly higher in groups exposed to more intensive decision support, but the differences were appreciably higher when decision aids were compared to usual care (WMD=17 out of 100,95%CI:14 to 21) than when more intensive and less intensive decision support interventions were compared (WMD=3 out of 100,95%CI: 1 to 5). Those exposed to more intensive decision support had significantly lower decisional conflict scores (WMD= -0.2 out of 5,95%CI -0.1 to -0.4 ), but no statistically significant differences in satisfaction with decisions (WMD=2 of 100, 95%CI:-0.2 to 4.6) or satisfaction with the decision making process (WMD= 3 out of 100, 95% CI:-0.7 to 6.2). Decision aids had a variable impact on participants' decisions. Compared to usual care, decision aids reduced preferences for major surgical options (OR=0.51,95%CI:0.34 to 0.77) and PSA tests (OR=0.66, 95%CI: 0.44 to 0.98). In contrast, decision aids had no impact on preferences for minor surgical options (OR=1.35,95%CI: 0.7 to 2.7) and increased preferences for other screening tests (OR= 1.35,95%CI: 1.1 to 1.6).
Discussion: Decision aids increase knowledge and reduce decisional conflict but have no significant overall impact on satisfaction. They have a variable impact on patients' choices. More studies are needed to determine what types of decision support work with which types of patients for which decisions. There is a need to standardize the reporting of the interventions in decision aids. Evaluation measures should be standardized and clinically important differences should be defined.
Objectives: Patient decision aids or "shared decision making programs" provide evidence-based information on health care options and outcomes to prepare patients for decision making with their practitioners. We conducted a Cochrane systematic review to evaluate their effectiveness on decision making and outcomes of decisions.
Methods: A literature search was performed using the MEDLINE, PsycINFO, CINAHL, Aidsline, CancerLit and EMBASE databases. In addition, the CCTR was searched, as well as the personal files of the authors. Inclusion criteria were: published in English; random allocation of interventions; participants older than 14 years and at the point of decision making; and interventions provided information on options and outcomes to support patients' decision making regarding specific treatment or screening choices. Two independent reviewers screened abstracts and extracted data using standardized forms. For continuous outcomes (knowledge, decisional conflict, satisfaction), weighted mean differences were calculated (WMD). For dichotomous outcomes (preference for most intensive option), odds ratios (OR) were calculated using fixed effects models.
Results: The database search yielded 10,387 unique abstracts, of which 500 focused on patient decision making. Eighteen studies met the inclusion criteria. Knowledge scores were significantly higher in groups exposed to more intensive decision support, but the differences were appreciably higher when decision aids were compared to usual care (WMD=17 out of 100,95%CI:14 to 21) than when more intensive and less intensive decision support interventions were compared (WMD=3 out of 100,95%CI: 1 to 5). Those exposed to more intensive decision support had significantly lower decisional conflict scores (WMD= -0.2 out of 5,95%CI -0.1 to -0.4 ), but no statistically significant differences in satisfaction with decisions (WMD=2 of 100, 95%CI:-0.2 to 4.6) or satisfaction with the decision making process (WMD= 3 out of 100, 95% CI:-0.7 to 6.2). Decision aids had a variable impact on participants' decisions. Compared to usual care, decision aids reduced preferences for major surgical options (OR=0.51,95%CI:0.34 to 0.77) and PSA tests (OR=0.66, 95%CI: 0.44 to 0.98). In contrast, decision aids had no impact on preferences for minor surgical options (OR=1.35,95%CI: 0.7 to 2.7) and increased preferences for other screening tests (OR= 1.35,95%CI: 1.1 to 1.6).
Discussion: Decision aids increase knowledge and reduce decisional conflict but have no significant overall impact on satisfaction. They have a variable impact on patients' choices. More studies are needed to determine what types of decision support work with which types of patients for which decisions. There is a need to standardize the reporting of the interventions in decision aids. Evaluation measures should be standardized and clinically important differences should be defined.