Investing in Deliberation: A Definition and Classification of Decision Support Interventions for People Facing Difficult Health Decisions

Glyn Elwyn, Dominick Frosch, Angelo E. Volandes, Adrian Edwards and Victor M. Montori
Additional contact information
Glyn Elwyn: Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, UK, elwyng@cardiff.ac.uk
Dominick Frosch: Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
Angelo E. Volandes: Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, UK
Adrian Edwards: Harvard Medical School, Massachusetts General Hospital, Boston, MA
Victor M. Montori: Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, MN

Medical Decision Making, 2010, vol. 30, issue 6, 701-711

Abstract: This article provides an analysis of ‘decision aids’, interventions to support patients facing tough decisions. Interest has increased since the concept of shared decision making has become widely considered to be a means of achieving desirable clinical outcomes. We consider the aims of these interventions and examine assumptions about their use. We propose three categories, interventions that are used in face-to-face encounters, those designed for use outside clinical encounters and those which are mediated, using telephone or other communication media. We propose the following definition: 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 help people to deliberate, independently or in collaboration with others, about options, by considering relevantattributes; they support people to forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences, in ways which help the process of constructing preferences and eventual decision making, appropriate to their individual situation. Although quality standards have been published for these interventions, we are also cautious about premature closure and consider that the need for short versions for use inside clinical encounters and long versions for external use requires further research. More work is also needed on the use of narrative formats and the translation of theory into practical designs. The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved.

Keywords: shared decision making; decision aids; decision support interventions; complex interventions (search for similar items in EconPapers)
Date: 2010
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:30:y:2010:i:6:p:701-711

DOI: 10.1177/0272989X10386231

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