Decision aids

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Decision aids are interventions or tools designed to facilitate shared decision making and patient participation in health care decisions.

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.[1] 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.[1] Decision aids can be of any type but are most commonly pamphlets, videos, or web-based tools.[2] Decision aids support the process of constructing preferences and eventual decision making, appropriate to their individual situation.[1]

Usage[edit]

There are numerous ways in which decision aids can be used.[1] 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.[3]

Efficacy[edit]

A Cochrane review came to the findings that when patients use decision aids they:[2]

  • 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.[2] 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.[2]

Producers[edit]

There are also many active research groups in the field, including the University of Ottawa, Dartmouth College, Cardiff University and Hamburg; the Agency for Healthcare Research and Quality uses the IPDAS standards[4] to produce its decision aids.[5]

Standards[edit]

There has been an increase in use of decision support and a global interest in developing these interventions among both for-profit and not-for-profit organisations.[6] It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of testing and evaluation. The International Patient Decision Aids Standards (IPDAS) Collaboration has published a checklist,[7] and, more recently, an assessment instrument (IPDAS)[8] to evaluate the quality of decision support interventions. In its November 2013 issue, BMC Medical Informatics and Decision Making published a supplement that described the 10-year evolution of the IPDAS Collaboration and 12 core dimensions for assessing the quality of patient decision aids.[9] While specifying minimum standards for patient decision support interventions is a feasible development, it is unclear whether the minimum standards can be applied to interventions designed for use within clinical encounters and to those that target screening and diagnostic tests.[10]

References[edit]

  1. ^ a b c d 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. 
  2. ^ a b c d Stacey, Dawn; Légaré, France; Col, Nananda F; Bennett, Carol L; Barry, Michael J; Eden, Karen B; Holmes-Rovner, Margaret; Llewellyn-Thomas, Hilary; Lyddiatt, Anne; Thomson, Richard; Trevena, Lyndal; Wu, Julie HC; Stacey, Dawn (2014). "Decision aids for people facing health treatment or screening decisions". Cochrane Database Syst Rev. 1: CD001431. doi:10.1002/14651858.CD001431.pub4. PMID 24470076. 
  3. ^ 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 1586024Freely accessible. PMID 16899124. 
  4. ^ "International Patient Decision Aids Standards (IPDAS) Collaboration". ipdas.ohri.ca. Retrieved 2016-09-19. 
  5. ^ "Patient Decision Aids | AHRQ Effective Health Care Program". www.effectivehealthcare.ahrq.gov. Retrieved 2016-09-19. 
  6. ^ 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. 
  7. ^ Elwyn G, O'Connor A, Stacey D, et al. (August 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 1553508Freely accessible. PMID 16908462. 
  8. ^ 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 2649534Freely accessible. PMID 19259269. 
  9. ^ "BMC Medical Informatics and Decision Making". BMC Medical Informatics and Decision Making. Retrieved 2016-09-19. 
  10. ^ Joseph-Williams, Natalie; Newcombe, Robert; Politi, Mary; Durand, Marie-Anne; Sivell, Stephanie; Stacey, Dawn; O'Connor, Annette; Volk, Robert J.; Edwards, Adrian (2014-08-01). "Toward Minimum Standards for Certifying Patient Decision Aids: A Modified Delphi Consensus Process". Medical Decision Making: An International Journal of the Society for Medical Decision Making. 34 (6): 699–710. doi:10.1177/0272989X13501721. ISSN 1552-681X. PMID 23963501. 

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