A systematic review of information in decision aids

Abstract

Objective We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate.Search strategy DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: Ôdecision aidÕ; shared decision makingÕ and ÔpatientsÕ; Ômultimedia or leaflets or pamphlets or videos and patients and decision makingÕ. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006.Data extraction Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences.Main results 68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patientsÕ guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide falsepositive than false-negative rates.Conclusions The review led us to be concerned about completeness, balance and accuracy of information included in DAs.

The sciences of science communication

“…That analysis might find that a few items provide all that most recipients need, or that target audiences have such diverse information needs that they require different brief messages, or that there are too many critical facts for any brief message to suffice. Without analysis, though, one cannot know what content is adequate (61).…”

Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

“…Decision support is a clinical skill whereby patients are provided with structured support during an explicit process of decision making that includes focused counseling, and in some cases employs a patient ''decision aid'' to enable them to make informed health care choices. [33][34][35] Patient decision aids are tools that help to clarify personal values and communicate information on the available options so that patients can make informed choices. Patient decision aids do not advise people to choose one option over another, nor are they meant to replace clinician consultation.…”

A randomized trial of a breast/ovarian cancer genetic testing decision aid used as a communication aid during genetic counseling

“…They typically include relevant information about a particular decision as well as methods for clarifying and expressing the patient's values [2]. Many studies have demonstrated that decision aids are acceptable to patients, reduce uncertainty, assist people to clarify values and make decisions congruent with those values; assist those who are uncertain in making choices, reduce the time taken to make a decision and result in greater adherence to, and satisfaction with, the decision made [3,4].…”