Featured Review: Decision aids to help people who are facing health treatment or screening decisions

Growing evidence to support the use of patient decision aids

Growing evidence to support the use of patient decision aids

Deciding on the best treatment or screening option can be hard. People can use decision aids when there is more than one option and neither is clearly better or when options have benefits and harms that people value differently. Decision aids may be pamphlets, videos, or web-based tools. They state the decision, describe the options, and help people think about the options from a personal view (e.g. how important are possible benefits and harms).

A team of Cochrane authors based in Canada, Australia, United Kingdom, and the United States worked with Cochrane Consumers and Communication to investigate the effects of decision aids on people facing health treatment or screening decisions. 18 new studies were added to a previous version of this review, bringing the total to 105 studies, involving 31,043 people. The decision aids focused on 50 different decisions; 89 studies evaluated a patient decision aid used by people in preparation for the visit with the clinician, and 16 studies evaluated its use during the visit with the clinician.

Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this update is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.

The original review was published in 2001 and it was last updated in 2014. “Updating this Review was important because there have been health policy changes in several countries since 2010 that require shared decision making and better patient engagement in health decisions. For example, the 2014 NICE Guidelines for Patient Experience recommend the use of high-quality patient decision aids for adults facing treatment or screening decisions and reference this Review,” says Dr Dawn Stacey, the lead author of the Cochrane Review. “We added 18 new studies to this update. This brought our total to 105 included studies and we had enough trials to conduct a sub-analysis that compared outcomes for patient decision aids used in preparation for the consultation versus in the consultation. Our findings showed that patient decision aids improve knowledge and realistic expectations without any difference between timing in their use.”

“A project stemming from this Cochrane Review is hosting the international inventory of patient decision aids rated against the International Patent Decision Aids Standards (IPDAS) criteria. We originally presented this information as a table in the Cochrane Review but we moved the inventory to a website so that it is accessible to the public and searchable,” added Dr. Stacey. “It’s a great resource for patients, caregivers, clinicians, and policy makers. Given the evidence supporting use of decision aids, we hope that they will be more widely used in clinical practice.”


Thursday, May 25, 2017