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'''Decision aids''' is the name commonly used to describe interventions that are designed for patients, or people facing healthcare decisions. They are used to facilitate [[shared decision making]]. A recent definition is cited: decision support interventions help people think about choices they face: they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions aim to help people to deliberate, independently or in collaboration with others, about options, by considering relevant attributes, to help them forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, they support people forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help support the process of constructing preferences and eventual decision making, appropriate to their individual situation<ref name="Ref 1">Elwyn G, Frosch D, Volandes A, Edwards A, Montori V. Investing in deliberation: defining and developing decision support interventions for people facing difficult health decisions. John M Eisenberg Center for Clinical Decisions and Communication: White Paper Series. Gaithersberg, Maryland, USA, 2009.</ref>.
'''Decision aids''' is the name commonly used to describe interventions that are designed for patients, or people facing healthcare decisions. They are used to facilitate [[shared decision making]]. A recent definition is cited: decision support interventions help people think about choices they face: they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions aim to help people to deliberate, independently or in collaboration with others, about options, by considering relevant attributes, to help them forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, they support people forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help support the process of constructing preferences and eventual decision making, appropriate to their individual situation<ref name="Ref 1">{{cite journal |author=Elwyn G, Frosch D, Volandes A, Edwards A, Montori V |title=Investing in deliberation: defining and developing decision support interventions for people facing difficult health decisions |publisher=John M Eisenberg Center for Clinical Decisions and Communication |series=White Paper Series |location=Gaithersberg, Maryland, USA |year=2009}}</ref>.


There are numerous ways in which decision support interventions can be used<ref name="Ref 1"/>. They can be brief enough to be used in clinical encounters. Or they can be designed to have sufficient content such that patients can use them both before or after clinical encounters, with the possibility that they are introduced and supported by decision coaches. Nevertheless, although these interventions have been in production since the early 1980s, there is evidence of considerable difficulty of implementation into routine practice<ref>Gravel K, Legare F, Graham I. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci 2006;1:16.</ref>. The mainstream producers of decision support interventions are based in North America, e.g. The Foundation for [http://www.fimdm.org/decision_sdms.php Informed Medical Decision Making] and [http://www.healthwise.org/ Healthwise]. There are also many active research groups in the field, e.g. at the [http://www.ohri.ca/DecisionAid/ University of Otawa], [http://tdi.dartmouth.edu/centers/informed-choice Dartmouth College], [http://www.decisionlaboratory.com/ Cardiff University] and Hamburg.
There are numerous ways in which decision support interventions can be used<ref name="Ref 1"/>. They can be brief enough to be used in clinical encounters. Or they can be designed to have sufficient content such that patients can use them both before or after clinical encounters, with the possibility that they are introduced and supported by decision coaches. Nevertheless, although these interventions have been in production since the early 1980s, there is evidence of considerable difficulty of implementation into routine practice<ref>{{cite journal |author=Gravel K, Légaré F, Graham ID |title=Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions |journal=Implement Sci |volume=1 |issue= |pages=16 |year=2006 |pmid=16899124 |pmc=1586024 |doi=10.1186/1748-5908-1-16 |url=http://www.implementationscience.com/content/1//16}}</ref>. The mainstream producers of decision support interventions are based in North America, e.g. The Foundation for [http://www.fimdm.org/decision_sdms.php Informed Medical Decision Making] and [http://www.healthwise.org/ Healthwise]. There are also many active research groups in the field, e.g. at the [http://www.ohri.ca/DecisionAid/ University of Otawa], [http://tdi.dartmouth.edu/centers/informed-choice Dartmouth College], [http://www.decisionlaboratory.com/ Cardiff University] and Hamburg.


Evidence from randomized trials has been summarized in a Cochrane systematic review<ref>O'Connor AM BC, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D,. Decision aids for people facing health treatment or screening decisions: Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD001431., 2009.</ref>. The most recent iteration in 2009 included 55 trials. This review confirmed the following findings from the previous (2003) review. Decision support interventions performed better than usual care interventions in terms of: a) greater knowledge; b) lower decisional conflict related to feeling uninformed; c) lower decisional conflict related to feeling unclear about personal values; d) reduced the proportion of people who were passive in decision making; and e) reduced proportion of people who remained undecided post-intervention. As in the previous review, exposure to continued to demonstrate reduced rates of: elective invasive surgery in favour of conservative options.
Evidence from randomized trials has been summarized in a Cochrane systematic review<ref>{{cite journal |author=O'Connor AM, Bennett CL, Stacey D, ''et al.'' |title=Decision aids for people facing health treatment or screening decisions |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001431 |year=2009 |pmid=19588325 |doi=10.1002/14651858.CD001431.pub210.1002/14651858.CD001431.pub2}}</ref>. The most recent iteration in 2009 included 55 trials. This review confirmed the following findings from the previous (2003) review. Decision support interventions performed better than usual care interventions in terms of: a) greater knowledge; b) lower decisional conflict related to feeling uninformed; c) lower decisional conflict related to feeling unclear about personal values; d) reduced the proportion of people who were passive in decision making; and e) reduced proportion of people who remained undecided post-intervention. As in the previous review, exposure to continued to demonstrate reduced rates of: elective invasive surgery in favour of conservative options.


There has been increasing use of decision support and a global interest in developing these interventions exists among both for-profit and not-for-profit organisations<ref>O'Connor AM, Wennberg J, Legare F, Llewellyn-Thomas H, Moulton B, al SKe. Towards the 'tipping point': decision aids and informed patient choice. Health Affairs 2007;26:716-25.</ref>. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.The International Patient Decision Aids Standards Collaboration has published a checklist<ref>Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ 2006;333:417-21.</ref>, and more recently, an assessment instrument named IPDASi<ref>Elwyn G, O'Connor AM, Bennett C, Newcombe RG, Politi M, Durand MA, Drake E, Joseph-Williams N, Khangura S, Saarimaki A, Sivell S, Stiel M, Bernstein SJ, Col N, Coulter A, Eden K, Härter M, Rovner MH, Moumjid N, Stacey D, Thomson R, Whelan T, van der Weijden T, Edwards A. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS One. 2009;4(3):e4705. Epub 2009 Mar 4. PubMed PMID: 19259269; PubMed Central PMCID: PMC2649534.</ref>, to evaluate the quality of decision support interventions. These Standards are in the process of being updated (2009). There are signs in the USA that legislation mandating the use of these interventions will be developed.
There has been increasing use of decision support and a global interest in developing these interventions exists among both for-profit and not-for-profit organisations<ref>{{cite journal |author=O'Connor AM, Wennberg JE, Legare F, ''et al.'' |title=Toward the 'tipping point': decision aids and informed patient choice |journal=Health Aff (Millwood) |volume=26 |issue=3 |pages=716–25 |year=2007 |pmid=17485749 |doi=10.1377/hlthaff.26.3.716 |url=http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=17485749}}</ref>. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.The International Patient Decision Aids Standards Collaboration has published a checklist<ref>{{cite journal |author=Elwyn G, O'Connor A, Stacey D, ''et al.'' |title=Developing a quality criteria framework for patient decision aids: online international Delphi consensus process |journal=BMJ |volume=333 |issue=7565 |pages=417 |year=2006 |month=August |pmid=16908462 |pmc=1553508 |doi=10.1136/bmj.38926.629329.AE |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=16908462}}</ref>, and more recently, an assessment instrument named IPDASi<ref>{{cite journal |author=Elwyn G, O'Connor AM, Bennett C, ''et al.'' |title=Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi) |journal=PLoS ONE |volume=4 |issue=3 |pages=e4705 |year=2009 |pmid=19259269 |pmc=2649534 |doi=10.1371/journal.pone.0004705 |url=http://dx.plos.org/10.1371/journal.pone.0004705}}</ref>, to evaluate the quality of decision support interventions. These Standards are in the process of being updated (2009). There are signs in the USA that legislation mandating the use of these interventions will be developed.


== References ==
== References ==
{{reflist}}
<references />


== External links ==
== External links ==
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* [[Patient participation]]
* [[Patient participation]]


[[Category:Decision theory]]
{{Uncategorized|date=November 2009}}
{{Uncategorized|date=November 2009}}

Revision as of 22:43, 18 November 2009

Decision aids is the name commonly used to describe interventions that are designed for patients, or people facing healthcare decisions. They are used to facilitate shared decision making. A recent definition is cited: decision support interventions help people think about choices they face: they describe where and why choice exists; they provide information about options, including, where reasonable, the option of taking no action. These interventions aim to help people to deliberate, independently or in collaboration with others, about options, by considering relevant attributes, to help them forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, they support people forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help support the process of constructing preferences and eventual decision making, appropriate to their individual situation[1].

There are numerous ways in which decision support interventions can be used[1]. They can be brief enough to be used in clinical encounters. Or they can be designed to have sufficient content such that patients can use them both before or after clinical encounters, with the possibility that they are introduced and supported by decision coaches. Nevertheless, although these interventions have been in production since the early 1980s, there is evidence of considerable difficulty of implementation into routine practice[2]. The mainstream producers of decision support interventions are based in North America, e.g. The Foundation for Informed Medical Decision Making and Healthwise. There are also many active research groups in the field, e.g. at the University of Otawa, Dartmouth College, Cardiff University and Hamburg.

Evidence from randomized trials has been summarized in a Cochrane systematic review[3]. The most recent iteration in 2009 included 55 trials. This review confirmed the following findings from the previous (2003) review. Decision support interventions performed better than usual care interventions in terms of: a) greater knowledge; b) lower decisional conflict related to feeling uninformed; c) lower decisional conflict related to feeling unclear about personal values; d) reduced the proportion of people who were passive in decision making; and e) reduced proportion of people who remained undecided post-intervention. As in the previous review, exposure to continued to demonstrate reduced rates of: elective invasive surgery in favour of conservative options.

There has been increasing use of decision support and a global interest in developing these interventions exists among both for-profit and not-for-profit organisations[4]. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.The International Patient Decision Aids Standards Collaboration has published a checklist[5], and more recently, an assessment instrument named IPDASi[6], to evaluate the quality of decision support interventions. These Standards are in the process of being updated (2009). There are signs in the USA that legislation mandating the use of these interventions will be developed.

References

  1. ^ a b Elwyn G, Frosch D, Volandes A, Edwards A, Montori V (2009). "Investing in deliberation: defining and developing decision support interventions for people facing difficult health decisions". White Paper Series. Gaithersberg, Maryland, USA: John M Eisenberg Center for Clinical Decisions and Communication. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  2. ^ Gravel K, Légaré F, Graham ID (2006). "Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions". Implement Sci. 1: 16. doi:10.1186/1748-5908-1-16. PMC 1586024. PMID 16899124.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  3. ^ O'Connor AM, Bennett CL, Stacey D; et al. (2009). "Decision aids for people facing health treatment or screening decisions". Cochrane Database Syst Rev (3): CD001431. doi:10.1002/14651858.CD001431.pub210.1002/14651858.CD001431.pub2. PMID 19588325. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  4. ^ O'Connor AM, Wennberg JE, Legare F; et al. (2007). "Toward the 'tipping point': decision aids and informed patient choice". Health Aff (Millwood). 26 (3): 716–25. doi:10.1377/hlthaff.26.3.716. PMID 17485749. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  5. ^ Elwyn G, O'Connor A, Stacey D; et al. (2006). "Developing a quality criteria framework for patient decision aids: online international Delphi consensus process". BMJ. 333 (7565): 417. doi:10.1136/bmj.38926.629329.AE. PMC 1553508. PMID 16908462. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  6. ^ Elwyn G, O'Connor AM, Bennett C; et al. (2009). "Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi)". PLoS ONE. 4 (3): e4705. doi:10.1371/journal.pone.0004705. PMC 2649534. PMID 19259269. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

External links

See also

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