Problem with patient decision aids

Zadro, Joshua R; Traeger, Adrian C; Décary, Simon; O’Keeffe, Mary

doi:10.1136/bmjebm-2020-111371

Cited by 12 publications

(18 citation statements)

References 20 publications

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“…On the other extreme were some physiotherapists, who suggested that Cochrane systematic reviews have underestimated the true harms of surgery. We did not change the evidence presented because it is vital numeric estimates of benefits and harms in decision aids are based on the highest quality available evidence 15 28…”

Section: Discussionmentioning

confidence: 99%

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

et al. 2021

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ObjectiveTo develop and user test a patient decision aid for people with subacromial pain syndrome that presents evidence-based information on the benefits and harms of subacromial decompression surgery and rotator cuff repair surgery.DesignMixed-methods study outlining the development of a patient decision aid.SettingWe assembled a multidisciplinary steering group, and used existing decision aids and decision science to draft the decision aid. Participants were recruited through social media (not restricted by country nor setting), local hospitals and the authors’ collaboration network.ParticipantsPeople with shoulder pain and health professionals who manage people with shoulder pain.Primary and secondary outcomesWe interviewed participants to gather feedback on the decision aid, assessed useability and acceptability (using qualitative and quantitative methods) and performed iterative cycles of redrafting the decision aid and reinterviewing participants as necessary. Interview data were analysed using thematic analysis. Quantitative data were summarised descriptively.ResultsWe interviewed 26 health professionals (11 physiotherapists, 7 orthopaedic surgeons, 4 general practitioners, 3 chiropractors and 1 osteopath) and 14 people with shoulder pain. Most health professionals and people with shoulder pain rated all aspects of decision aid acceptability as adequate-to-excellent (eg, length, presentation, comprehensibility). Interviews highlighted agreement among health professionals and people with shoulder pain on most aspects of the decision aid (eg, treatment options, summary of benefits, harms and practical issues, questions to ask a health professional, graphics, formatting). However, some aspects of the decision aid elicited divergent views among health professionals (eg, causes and symptoms of shoulder pain, evidence on benefits and harms).ConclusionThis decision aid could be an acceptable and valuable tool for helping people with subacromial pain syndrome make informed treatment choices. A randomised controlled trial evaluating whether this decision aid reduces people’s intentions to undergo shoulder surgery and facilitates informed treatment choices is underway.Trial registration number ACTRN12621000992808

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Section: Discussionmentioning

confidence: 99%

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

et al. 2021

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“…Another highlight of the research is the limitation of adequately translating evidence from CPG recommendations [ 63 ]. One of these limitations may be that the guidelines for PtDA development may not be sufficient to ensure that developers select the best available evidence and present the evidence appropriately.…”

Section: Discussionmentioning

confidence: 99%

Decision aids linked to the recommendations in clinical practice guidelines: results of the acceptability of a decision aid for patients with generalized anxiety disorder

Ramos‐García

Perestelo-Pérez

Rivero-Santana

et al. 2022

BMC Med Inform Decis Mak

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Background Generalized anxiety disorder (GAD) is one of the most prevalent mental health problems. Patients with GAD have unmet needs related to the information received about their disorder, its treatments and their participation in the decision-making process. The aim of this study is to develop and assess the acceptability of a patient decision aid (PtDA) for patients with GAD. Method The PtDA was developed following the International Patient Decision Aid Standards. The recommendations of the Spanish clinical practice guideline (CPG) for patients with GAD were used as the basis. The first prototype was developed by an expert committee, further improvements were made with patients (n = 2), clinical experts (n = 13) and the project management group (n = 7). The acceptability of this second draft was assessed by patients non-involved in the previous phases (n = 11). Results The final PtDA version included a brief description of GAD and its treatments. Most participants agreed that the PtDA was easy to use, visually appealing and useful. At least half of the participants learned new things about treatments and adverse effects. Conclusions A PtDA was developed for patients with GAD based on recommendations from the Spanish CPG. It was improved and accepted by patients and clinical experts involved. An evaluation of its effectiveness on the shared decision-making process during the clinical encounter is planned.

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“…In contrast, we consider our evidence reviews comprehensive and well documented. On the other hand, we clearly acknowledge the challenges identified by Zadro et al [ 24 ], who states: “If only low-certainty evidence is available this could leave patients more uncertain than before they read the decision aid. … it is important to consider whether sufficient evidence exists to reasonably produce a well-balanced patient decision aid.” Dealing with often low-quality best available evidence resulting from a high-quality review of the evidence was indeed a huge challenge also in this project.…”

Section: Discussionmentioning

confidence: 75%

“…Several recent reviews of published PtDAs suggest a lack of well documented evidence review and summarization processes [ 11 , 12 , 24 ]. In contrast, we consider our evidence reviews comprehensive and well documented.…”

Section: Discussionmentioning

confidence: 99%

A scattered landscape: assessment of the evidence base for 71 patient decision aids developed in a hospital setting

Danner

Debrouwere

Rummer

et al. 2022

BMC Med Inform Decis Mak

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Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale “Share to Care (S2C)” Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments’ impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe how PtDAs are developed and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence. Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Results Evidence reviews assessed on average 25 systematic reviews/guidelines/studies and took about 3 months to be completed. Despite rigorous review processes, nearly 70% of outcome-specific information derived for decision aids was based on low-quality and mostly on non-directly comparative evidence. Evidence on quality of life and harms was often not provided or not in sufficient form/detail. Challenges in evidence interpretation for use in decision aids resulted from, e.g., a lack of directly comparative evidence or the existence of very heterogeneous evidence for the diverse treatments being compared. Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a “scattered landscape” and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn’t mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients.

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Problem with patient decision aids

Cited by 12 publications

References 20 publications

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

Development of a patient decision aid on subacromial decompression surgery and rotator cuff repair surgery: an international mixed-methods study

Decision aids linked to the recommendations in clinical practice guidelines: results of the acceptability of a decision aid for patients with generalized anxiety disorder

A scattered landscape: assessment of the evidence base for 71 patient decision aids developed in a hospital setting

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