Decision aids for people facing health treatment or screening decisions

Stacey, Dawn; Lewis, Krystina B.; Barry, Michael J.; Bennett, Carol; Eden, Karen; Holmes‐Rovner, Margaret; Llewellyn‐Thomas, Hilary A.; Lyddiatt, Anne; Thomson, Richard; Trevena, Lyndal

doi:10.1002/14651858.cd001431.pub5

Cited by 3,427 publications

(2,861 citation statements)

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“…Finally, we performed a hand-search of the 2014 Cochrane Collaboration review and found six DA interventions that met our criteria. 14 We found that only one article was not previously discovered in our search of PubMed.…”

Section: Study Selection and Data Extractionmentioning

confidence: 97%

“…Based on established models of SDM and DAs, 14 we included studies with an intervention that included 1) information sharing or education and 2) risks and benefits of treatment options, to enable SDM. Studies in which < 50 % of the participants identified as part of a racial (African American, Asian American), ethnic (Hispanic/Latino), sexual (LGB) or gender (Transgender) minority were excluded.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…DAs are educational tools designed to encourage patients to participate in medical decisions by displaying the benefits and harms of treatment options and by eliciting patient preferences, particularly for decisions with scientific uncertainty. 14 Over the past several decades, the field has matured significantly. There are now over 115 DAs described in the literature and established best practices for evaluating DAs.…”

Section: Introductionmentioning

confidence: 99%

“…There are now over 115 DAs described in the literature and established best practices for evaluating DAs. 14 Despite the extensive DA literature, we know little about how frequently minority populations experience DAs or how much they have been tailored to their populations' specific needs (e.g., low literacy). We reviewed existing randomized controlled trials (RCTs) that examine DAs with underrepresented minority populations.…”

Section: Introductionmentioning

confidence: 99%

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Use of Decision Aids with Minority Patients: a Systematic Review

et al. 2016

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BACKGROUND:One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities. METHODS: We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05. RESULTS: We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs. DISCUSSION: DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.KEY WORDS: shared decision making; disparities; race and ethnicity; minority health; systematic reviews; medical decision making.

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Section: Study Selection and Data Extractionmentioning

confidence: 97%

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of Decision Aids with Minority Patients: a Systematic Review

et al. 2016

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“…Dr. Shannin could also explain nonpharmacologic alternatives (e.g., patient reassurance and redirection) and pharmacologic alternatives (e.g., antidepressants) to olanzapine. Option talk might also make use of decision support aids such as pamphlets, videos, or reputable websites, which have been shown to lead to improved patient knowledge, more accurate perception of risks and benefits, and greater participation in decision making [15]. The idea is that patients are supported in the deliberation process throughout and given ample time to make a final decision, which can take more than one encounter [14].…”

Section: Shared Decision Makingmentioning

confidence: 99%

Prescribing “Off-Label”: What Should a Physician Disclose?

Furey

Wilkins

2016

AMA Journal of Ethics

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This case highlights clinical dilemmas faced by physicians when treating patients with conditions for which there are limited or no FDA-approved treatment options. First, it raises questions about when it is appropriate to prescribe medications for "off-label" indications and what might be the ethical and legal implications of doing so. It also prompts us to consider why pharmaceutical companies might or might not pursue FDA approval for new indications when a drug has already been approved for use in another condition. Finally, this case demonstrates the importance of employing shared decision making when discussing complex clinical decisions and how such techniques might have led to different outcomes and better understanding between Dr. Shannin, Maxine, and Heather. CaseHeather brings her 89-year-old mother, Maxine, to the office of her psychiatrist, Dr. Shannin, for an evaluation. Maxine lives with Heather's family, and though she has been diagnosed with dementia, she still sees Dr. Shannin in his office by herself while Heather waits for her in his office lobby. During her last visit with Dr. Shannin three months ago, Maxine reported that whenever she got confused, she began to think that the people around her were going to harm her. Heather also expressed concerns about Maxine's confusion and paranoia, since Maxine would typically respond to those feelings by acting out as if she were being threatened. Maxine was unable to remember these outbursts, but she did remember feeling agitated and did note that Heather seemed very upset when she felt that way. At that time, Dr. Shannin suggested that Maxine try an atypical antipsychotic, olanzapine, to help control her agitation and paranoia. He explained the risks and benefits in detail and also explained that while he'd had good results with several patients with this medication in the past, managing confusion, agitation, and paranoia was not what this medication is really for. Maxine felt confident that Dr. Shannin had used this medication to manage these symptoms for his other patients, however, and so she agreed to begin taking olanzapine, which has managed her symptoms well for the last three months.Maxine's dementia has progressed significantly since her last visit with Dr. Shannin, and she is having a particularly bad day today: she doesn't recognize her longtime physician

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Sliding-Scale Shared Decision Making for Patients With Reduced Capacity

Lahey

Elwyn

2020

AMA Journal of Ethics

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Shared decision making honors patient autonomy, particularly for preference-sensitive care decisions. Shared decision making can be challenging, however, when patients have impaired decision-making capacity. Here, after presenting an illustrative case example, this paper proposes a capacity-adjusted "sliding scale" approach to shared decision making. CaseDr Q is an academic hepatologist meeting a new patient, Mr R, for newly diagnosed cirrhosis. The patient has clear signs of liver dysfunction and has already been admitted to the hospital previously for a gastrointestinal bleed related to esophageal varices. He also has chronic obstructive pulmonary disease, obesity, and poorly controlled type 2 diabetes mellitus.Dr Q and her student, Ms G, interview and examine Mr R together. They learn that Mr R did not complete high school and lives on what he calls "the wrong side of the tracks." He lives alone and drinks 4 beers daily. He thinks his brother might have had "liver problems," too.As the conversation unfolds, it becomes clear that Mr R does not know why he's in clinic today. "My doc said it was something about my liver, but…" He shrugs.Ms G and Dr Q teach Mr R about cirrhosis. They emphasize the importance of alcohol abstinence and start to explain that further workup is necessary-including, potentially, a liver biopsy. Their goal is to enter into shared decision making with Mr R about liver biopsy. Mr R holds up his hand midway through their explanation and says, "I'm not a detail guy, Doc. I trust you. You tell me what to do, and I'll do it." They talk more, and, ultimately, Dr Q asks, "Do you have any questions for me?" Mr R pauses for a second, starts to ask a question, and then tapers off. 1 Finally, he says, "Whatever you say, Doc. I'm in your hands."

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Decision aids for people facing health treatment or screening decisions

Cited by 3,427 publications

References 499 publications

Use of Decision Aids with Minority Patients: a Systematic Review

Use of Decision Aids with Minority Patients: a Systematic Review

Prescribing “Off-Label”: What Should a Physician Disclose?

Sliding-Scale Shared Decision Making for Patients With Reduced Capacity

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