Alongside the many thousands of Cochrane reviews of the effects of health care interventions, is a review of decision aids that might help people make decisions about treatment or screening. This was first published in January 2003 and the fifth update has been published 21 years later. Here's the current lead author, Dawn Stacey from the University of Ottawa and Ottawa Hospital Research Institute in Canada, who's been working on the review for all that time to tell us about the need for the review and its latest findings.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Alongside the many thousands of Cochrane reviews of the effects of health care interventions, is a review of decision aids that might help people make decisions about treatment or screening. This was first published in January 2003 and the fifth update has been published 21 years later. Here's the current lead author, Dawn Stacey from the University of Ottawa and Ottawa Hospital Research Institute in Canada, who's been working on the review for all that time to tell us about the need for the review and its latest findings.
Dawn: In health care, many treatment and screening decisions have no single best choice. There are often multiple options and people need to consider the potential benefits and side effects or harms associated with each option to decide on the best choice for their personal situation. They usually make these decisions together with their healthcare professional and patient decision aids can help. These include pamphlets or videos available in person or online. The decision aids clearly identify the healthcare decision, provide information on options including benefits and harms, and help people clarify what is most important to them.
In our Cochrane Review, we've investigated how well patient decision aids worked for helping people make healthcare decisions and have updated it every 3 to 5 years since 1999. For this update, we identified 209 studies involving more than 100,000 participants in 19 countries. The studies covered 71 different decisions. Common decisions were about screening or surgery for cancer, surgery for joint replacement, birth options after a previous cesarian, and medical treatments for atrial fibrillation, depression, or diabetes. Each study evaluated the patient decision aid compared to usual care, which may have been general patient information or nothing.
Compared to usual care, people who were given a patient decision aid were able to make better quality decisions, had higher knowledge and more accurate risk perceptions, felt more informed and had a more active role in decision making. When the decision aid was used in preparation for the consultation, there was no difference in time but when it was used in the consultation these lasted 1.5 minutes longer, on average. Finally, patient decision aids did not cause any unwanted effects such as decision regret.
We have high confidence in the evidence for most of our conclusions so, in summary, there continues to be positive effects of patient decision aids on the quality of the decision and the decision-making process across a wide range of decisions. There is sufficient evidence for using them in clinical practice, and patient decision aids satisfy 4 of 5 elements of the quintuple aim of including better patient experiences, better patient outcomes, reduced inequities, and improved clinician experiences. In fact, earlier versions of the review have been cited more than 120 times in clinical practice guidelines recommending the use of patient decision aids. However, we need to continue with updating the review because further research is needed on adherence, costs, resource use, and the effects in resource limited countries, such as in Africa.
Mike: If you would like to learn more about the more than 200 studies in Professor Stacey's review and the various decision aids that have been tested, the full review is available online at Cochrane Library dot com. If you go to the website and search 'decision aids for treatment and screening' you'll find the review, and any future updates.