Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis

Annette M. O'Connor, Dawn Stacey, Michael J. Barry, Nananda F. Col, Karen B. Eden, Vikki Entwistle, Valerie Fiset, Margaret Holmes-Rovner, Sara Khangura, Hilary Llewellyn-Thomas and David R. Rovner
Additional contact information
Annette M. O'Connor: Ottawa Health Research Institute, Canada, University of Ottawa, Canada, ohdec@ohri.ca
Dawn Stacey: University of Ottawa, Canada
Michael J. Barry: Massachusetts General Hospital, Boston
Nananda F. Col: Maine Medical Center, Portland, Maine
Karen B. Eden: Oregon Health and Science University, Portland
Vikki Entwistle: Social Dimensions of Health Institute, Dundee, UK
Valerie Fiset: Algonquin College, Ottawa, Canada
Margaret Holmes-Rovner: Michigan State University, East Lansing
Sara Khangura: Ottawa Health Research Institute, Canada
Hilary Llewellyn-Thomas: Dartmouth Medical School, Hanover, New Hampshire
David R. Rovner: Michigan State University, East Lansing

Medical Decision Making, 2007, vol. 27, issue 5, 554-574

Abstract: Objective. To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS). Data sources. Five electronic databases (to July 2006) and personal contacts (to December 2006). Results. Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = —8.4, 95% CI = —11.9 to —4.8; unclear values WMD = —6.3, 95% CI = —10.0 to —2.7). There was no difference in process measures when detailed and simple PtDAs were compared. Conclusions. PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.

Keywords: Key words: decision support techniques; patient education; patient participation; randomized controlled trials. (Med Decis Making 2007; 27:554—574) (search for similar items in EconPapers)
Date: 2007
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Citations: View citations in EconPapers (9)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:27:y:2007:i:5:p:554-574

DOI: 10.1177/0272989X07307319

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