Decision support interventions help people think about choices they face; they describe where and why choice exists; and 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. Decision aids can be of any type but are most commonly pamphlets, videos, or web-based tools. Decision aids support the process of constructing preferences and eventual decision making, appropriate to their individual situation.
There are numerous ways in which decision aids can be used. They can be brief enough to be used during a clinical encounter or they can have sufficient content to be used before or after clinical encounters. Although decision aids have been available since the early 1980s, evidence suggests that they are not well integrated into routine practice.
- improve their knowledge of the options
- feel more informed and more clear about what matters most to them
- have more accurate expectations of possible benefits and harms of their options
- participate more in decision making
- have better communication with their health practitioner
Exposure to decision aids demonstrated reduced rates of elective invasive surgery in favour of conservative options. More detailed decision aids are better than simple ones for improving knowledge and lowering decisional conflict related to feeling uninformed and unclear about personal values.
The mainstream producers of decision support interventions are based in North America, including The Informed Medical Decisions Foundation and Healthwise. There are also many active research groups in the field, including the University of Ottawa, Dartmouth College, Cardiff University and Hamburg. A multilingual comprehensive collection of decision aids is at www.Med-Decs.org.
There has been an increase in use of decision support and a global interest in developing these interventions exists among both for-profit and not-for-profit organisations. 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 (IPDAS) Collaboration has published a checklist, and, more recently, an assessment instrument named IPDASi that is designed 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.
- 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.
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- 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.