Article type
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Abstract
Background: depression affects around 4.4% of the global population and represents the leading cause of disability worldwide. Within the management of depression, it is important to take into account patients’ preferences, needs, and values, since treatment choice or their side effects can affect different aspects of their lives. Decision aids (DA) are tools or technologies used to help patients make informed decisions that offer not only information about treatment options, but also help patients construct, clarify and communicate their values. The usage of DA can potentially enhance the involvement in treatment choice and self-determination of patients, generate higher participant satisfaction, and improve adherence to treatment which can translate in lower depression scores. However, the effects of DA on patients who suffer from depression is not clear.
Objectives: to assess the effects of DA on decision-related outcomes and treatment of depression in adults.
Methods: during January 2019, we performed a systematic search in five databases to identify randomized control trials (RCTs) that reported the effect of DA on decision-related outcomes and response to treatment in adults with depression. No restrictions were applied. Two independent reviewers performed study selection and data extraction. We calculated standardized mean differences (SMD) and their 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42019121878).
Results: six RCTs that assessed a total of 1369 patients were eligible for inclusion. We found a beneficial effect on treatment satisfaction (SMD: 0.69; 95% CI 0.26 to 1.13) and information exchange (SMD: 0.51; 95% CI 0.19 to 0.82). However, we found no effect on doctor facilitation (SMD: 0.36; 95% CI -0.77 to 1.48), adherence to treatment (SMD: 0.16; 95% CI -0.14 to 0.73) or depression symptoms (SMD: -0.06; 95% CI -0.22 to 0.09). All outcomes had a very low certainty of evidence according to GRADE methodology (Table 1).
Conclusions: evidence of very low certainty suggests that, in adults with depression, DA has a beneficial effect in treatment satisfaction and information exchange but this does not translate into improved doctor facilitation, adherence to treatment, and lower depression scores. Well-designed studies, with bigger sample size, and adequate reporting of results are needed to improve the certainty of evidence.
Patient or healthcare consumer involvement: our study suggests that some decision-related outcomes improve when using DA in a shared-decision making context in patients with depression. Thus, the usage of DA could potentially be included within the initiatives to perform shared-decision making so as to improve patient-focused health care.
Objectives: to assess the effects of DA on decision-related outcomes and treatment of depression in adults.
Methods: during January 2019, we performed a systematic search in five databases to identify randomized control trials (RCTs) that reported the effect of DA on decision-related outcomes and response to treatment in adults with depression. No restrictions were applied. Two independent reviewers performed study selection and data extraction. We calculated standardized mean differences (SMD) and their 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42019121878).
Results: six RCTs that assessed a total of 1369 patients were eligible for inclusion. We found a beneficial effect on treatment satisfaction (SMD: 0.69; 95% CI 0.26 to 1.13) and information exchange (SMD: 0.51; 95% CI 0.19 to 0.82). However, we found no effect on doctor facilitation (SMD: 0.36; 95% CI -0.77 to 1.48), adherence to treatment (SMD: 0.16; 95% CI -0.14 to 0.73) or depression symptoms (SMD: -0.06; 95% CI -0.22 to 0.09). All outcomes had a very low certainty of evidence according to GRADE methodology (Table 1).
Conclusions: evidence of very low certainty suggests that, in adults with depression, DA has a beneficial effect in treatment satisfaction and information exchange but this does not translate into improved doctor facilitation, adherence to treatment, and lower depression scores. Well-designed studies, with bigger sample size, and adequate reporting of results are needed to improve the certainty of evidence.
Patient or healthcare consumer involvement: our study suggests that some decision-related outcomes improve when using DA in a shared-decision making context in patients with depression. Thus, the usage of DA could potentially be included within the initiatives to perform shared-decision making so as to improve patient-focused health care.
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