Decision aids
Encyclopedia
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 the process of constructing preferences and eventual decision making, appropriate to their individual situation.
There are numerous ways in which decision support interventions can be used. 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. 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 Ottawa, Dartmouth College, Cardiff University and Hamburg. A multilingual comprehensive collection of decision aids is at www.thedecisionaidcollection.nl.
Evidence from randomized trials has been summarized in a Cochrane systematic review. 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) smaller proportion of people who were passive in decision making; and e) smaller proportion of people who remained undecided post-intervention. As in the previous review, exposure to decision aids demonstrated 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. 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, and more recently, an assessment instrument named IPDASi, 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.
Shared decision making
Shared decision-making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed...
. 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 the process of constructing preferences and eventual decision making, appropriate to their individual situation.
There are numerous ways in which decision support interventions can be used. 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. 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 Ottawa, Dartmouth College, Cardiff University and Hamburg. A multilingual comprehensive collection of decision aids is at www.thedecisionaidcollection.nl.
Evidence from randomized trials has been summarized in a Cochrane systematic review. 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) smaller proportion of people who were passive in decision making; and e) smaller proportion of people who remained undecided post-intervention. As in the previous review, exposure to decision aids demonstrated 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. 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, and more recently, an assessment instrument named IPDASi, 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.