Patient decision aids are pamphlets, videos, or web-based tools to support active patient participation in decision making about health treatment or screening options. They outline the benefits and harms of specific options for treatment or screening and help patients clarify their personal values relating to the features and outcomes of the options.
Do decision aids help patients make better treatment choices?
Summary: When patients are given decision aids, such as educational booklets, DVDs, or interactive tools, to help them make treatment choices, they are more knowledgeable and satisfied with their care.
How many studies have been conducted on the patient decision aid?
We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. We included 105 studies involving 31,043 participants.
What is the business case for decision aids?
There is a clear business case for the use of decision aids to promote safe, recommended care and reduce unwarranted variation in health systems that receive global or per capita payments to manage the overall care for a patient population.
What are the secondary effects of patient decision aid on outcome?
Secondary outcomes were behavioural, health, and health system effects. We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation.
What are the aids to decision making?
Six SDM key elements can be identified: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences, and making the decision. The International Patient Decision Aid Standards (IPDAS) require that a decision aid (DA) support these key elements.
What are the other types of patient decision making options?
A theoretical model on medical decision making is categorized into 4 types according to the role of the staff providing the medical service, that is, paternalistic, informed, agent, and shared [7-9].
How do you develop a patient decision aid?
Key features common to all patient decision aid (PtDA) development processes include: scoping and design; development of a prototype; 'alpha' testing with patients and clinicians in an iterative process; 'beta' testing in 'real life' conditions (field tests); and production of a final version for use and/or further ...
What is treatment decision making?
Treatment decision making (TDM) is complex due to the varying decisions which have to be made about diagnosis, treatment options, toxicity, and outcomes of treatment. Shared decision making is complicated by the triadic relationship of parent/caregiver, child and clinician typical in pediatric care.
What are three examples of decision making factors for healthcare?
Shared decision-making in healthcare and improve patient health outcomes and support patient-centeredness during care encounters.Strong patient education, decision aids.Understanding patient cultural and personal preferences.Engaging family and caregivers.
What must healthcare professionals do to help patients make decisions about their treatment?
Healthcare professionals must inform patients about advance directives and what types of treatments they may choose to accept or not accept. Copies of the advance directive (or its key points) must be in the patient's charts.
What is evidence based decision making in healthcare?
Evidence-based practice is the use of the best available evidence together with a clinician's expertise and a patient's values and preferences in making health care decisions.
What is shared decision making in nursing?
Shared decision making is a joint process in which a healthcare professional works together with a person to reach a decision about care. It involves choosing tests and treatments based both on evidence and on the person's individual preferences, beliefs and values.
What are disadvantages of shared decision making?
Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient ...
What are the steps in decision-making?
Decision making is the process of making choices by identifying a decision, gathering information, and assessing alternative resolutions....Step 1: Identify the decision. ... Step 2: Gather relevant information. ... Step 3: Identify the alternatives. ... Step 4: Weigh the evidence. ... Step 5: Choose among alternatives.More items...•
What are the treatment options?
Treatment OptionsRadiation therapy.Chemotherapy/Infusion.Clinical trials.Inpatient care.Rehabilitation.
What is the first step of the decision-making process?
The first step in the decision making process is Identifying a problem which means examine the problem more closely and understand the cause of a problem.
Why are decision aids important?
There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included.
What is decision aid?
Decision aids for people facing health treatment or screening decisions. There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence ...
What are the effects of decision aids?
The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.
Do decision aids affect length of consultation?
There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction.
How do decision aids help patients?
Instead of elective surgery, patients using decision aids opted for "conservative options," including medication, physical therapy, and waiting, more often than those not using decision aids. RAND and others have found that up to 25 percent of elective surgery is unnecessary. Evidence of overuse or misuse in other medical procedures is widespread. For example, recent news stories focused on a federal investigation of thousands of potentially inappropriate angioplasty and other cardiac procedures in the for-profit chain of HCA hospitals.
What is the role of decision aids in decision making?
Because decision aids play a vital role in the shared decision making process, a number of research groups, companies, and health systems have been developing them.
What are the barriers to using decision aids?
In surveys, practices list among the main barriers to using decision aids the fact that they didn't have a way to identify patients who would benefit from the decision aids, lack of time to distribute them, too many other educational materials, and lack of clinician support.
Why use decision aids?
There is a clear business case for the use of decision aids to promote safe, recommended care and reduce unwarranted variation in health systems that receive global or per capita payments to manage the overall care for a patient population. But it will likely take new incentives to encourage providers working in fee-for-service environments to adopt decision aids. "When doctors are being paid not for episodes of care but quality of care—that's going to make a difference," says Martin Gabica, M.D., chief medical officer at Healthwise, a nonprofit that develops health information and interactive decision tools.
How does shared decision making improve patient satisfaction?
And a comprehensive review by the Cochrane Collaboration found the use of decision aids, in particular, improves patients' knowledge of and satisfaction with their care. Patients viewing decision aids also chose to pursue major elective invasive surgery less often—a finding that has caught the attention of those hoping to reduce overuse or misuse: research has shown that as much as 25 percent of elective surgery may be unnecessary or inappropriate. 2 But in spite of the evidence that patients value the tools and learn from them, and in spite of their potential to reduce inappropriate use and control costs, decision aids and shared decision making are not in widespread use. "Given the level of evidence, this may be one of the best-documented but underused intervention in American medicine," says Michael J. Barry, M.D., president of the Informed Medical Decisions Foundation, a nonprofit that develops and disseminates shared decision making tools. (See Q&A with Richard Wexler, director of patient support strategies at the Informed Medical Decisions Foundation.)
What is shared decision making?
But the use of such aids as part of "shared decision making"—a communication approach that seeks to balance clinicians' expertise with patients' preferences —has until recently been limited to research trials. Now some health systems and public policymakers are supporting more widespread use of shared decision making in efforts to promote patient engagement, reduce inappropriate use, and control costs.
Which state passed the law in 2007 to protect physicians who document that decision aids were used during the informed consent process?
An added incentive is greater liability protection: in 2007, Washington became the first state to pass legislation establishing increased legal protection to physicians who clearly document that decision aids were used during the informed consent process. 3.
What is a decision aid?
Decision aids for people facing health treatment or screening decisions. 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.
How many studies were included in the Risk of Bias?
During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup.
Do decision aids report adverse events?
Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception.
The link to patient satisfaction
A primary concern for doctors is time pressure—a factor that is linked to burnout, according to studies. They may feel that they do not have adequate time to learn and integrate decision aids into their busy daily schedules. But evidence shows this fear is unfounded.
Examples of interactive decision aids in action
Rendia is committed to improving the patient experience through interactive, video-based patient education technology. We equip health care professionals with the tools that help build trust and confidence in doctors’ recommendations. We believe that showing patients what to expect is far more effective than simply telling them.
Increase involvement in care decisions and maximize conversions
Decision aids like Rendia give patients a better understanding of their options, making them feel more involved in their care decisions.
The Link to Patient Satisfaction
Examples of Interactive Decision Aids in Action
- Rendia is committed to improving the patient experience through interactive, video-based patient education technology. We equip health care professionals with the tools that help build trust and confidence in doctors’ recommendations. We believe that showing patients what to expect is far more effective than simply telling them. That’s where tools such as Exam Mode play an importa…
Increase Involvement in Care Decisions and Maximize Conversions
- Decision aids like Rendia give patients a better understanding of their options, making them feel more involved in their care decisions. There are many ways to integrate decision aids into your workflow: you can email videos to your patients before their appointment to explain conditions and treatments, show product videos on iPads or flat screens ...