Article type
Abstract
Background: Patient decision aids (PDAs) outline evidence-based and unbiased information about a health condition and treatment options. Within a clinical care setting, they can help shift decision-making from a traditional, paternalistic model to a collaborative approach, by clarifying patients' values and preferences.
Successful implementation of PDAs requires addressing patient and clinician factors, such as health literacy, positive attitudes towards shared decision-making, willingness to use PDAs, and sufficient consultation time, along with system factors like a supportive environment and PDAs integration into routine clinical processes.
Objectives: To explore the role for PDAs in Singapore, considering their effectiveness, patient and clinician factors, and system factors.
Methods: A rapid literature review of papers published between 2015 and mid-2023 in MEDLINE, Embase, and PsycINFO was conducted, supplemented by a 2017 systematic review on the impact of PDAs in treatment or screening decisions. Additionally, feedback was obtained from the Agency for Care Effectiveness (ACE) Consumer Panel, comprising individuals from local patient organisations representing diverse health conditions, regarding utility and potential implementation challenges of PDAs.
Results: Both reviews found that, compared to placebo or usual care, PDAs significantly improved patient knowledge, decision-making, and communication but had no impact on anxiety levels or general and condition-specific health outcomes. No adverse events were associated with PDAs. The potential cost savings of PDAs in healthcare settings remained uncertain.
The ACE Consumer Panel expressed receptiveness towards PDAs, recognising their value in clarifying options and potential risks. However, they cautioned that the targeted focus of a PDA may limit holistic clinician-patient decision-making discussions. Importantly, they perceived that Singapore may not be fully prepared for PDAs, as not all patients actively participate in shared decision-making with clinicians treating them as equal partners, compounded by limited consultation time.
Conclusions: PDAs improve patient knowledge and communication with clinicians, but there is no clear evidence that they outperform usual care or placebo in patient-related health outcomes. The cost-effectiveness of PDAs remains uncertain. Furthermore, considering stakeholder readiness in Singapore is low, ACE will continue to monitor the evidence for PDA use for now. Promoting shared decision-making among patients may pave the way for future PDA implementation.
Successful implementation of PDAs requires addressing patient and clinician factors, such as health literacy, positive attitudes towards shared decision-making, willingness to use PDAs, and sufficient consultation time, along with system factors like a supportive environment and PDAs integration into routine clinical processes.
Objectives: To explore the role for PDAs in Singapore, considering their effectiveness, patient and clinician factors, and system factors.
Methods: A rapid literature review of papers published between 2015 and mid-2023 in MEDLINE, Embase, and PsycINFO was conducted, supplemented by a 2017 systematic review on the impact of PDAs in treatment or screening decisions. Additionally, feedback was obtained from the Agency for Care Effectiveness (ACE) Consumer Panel, comprising individuals from local patient organisations representing diverse health conditions, regarding utility and potential implementation challenges of PDAs.
Results: Both reviews found that, compared to placebo or usual care, PDAs significantly improved patient knowledge, decision-making, and communication but had no impact on anxiety levels or general and condition-specific health outcomes. No adverse events were associated with PDAs. The potential cost savings of PDAs in healthcare settings remained uncertain.
The ACE Consumer Panel expressed receptiveness towards PDAs, recognising their value in clarifying options and potential risks. However, they cautioned that the targeted focus of a PDA may limit holistic clinician-patient decision-making discussions. Importantly, they perceived that Singapore may not be fully prepared for PDAs, as not all patients actively participate in shared decision-making with clinicians treating them as equal partners, compounded by limited consultation time.
Conclusions: PDAs improve patient knowledge and communication with clinicians, but there is no clear evidence that they outperform usual care or placebo in patient-related health outcomes. The cost-effectiveness of PDAs remains uncertain. Furthermore, considering stakeholder readiness in Singapore is low, ACE will continue to monitor the evidence for PDA use for now. Promoting shared decision-making among patients may pave the way for future PDA implementation.