A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

Renata W. Yen, Jenna Smith, Jaclyn Engel, Danielle Marie Muscat, Sian K. Smith, Julien Mancini, Lilisbeth Perestelo-Pérez, Glyn Elwyn, A. James O’Malley, JoAnna K. Leyenaar, Olivia Mac, Tamara Cadet, Anik Giguere, Ashley J. Housten, Aisha Langford, Kirsten McCaffery and Marie-Anne Durand
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Renata W. Yen: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Jenna Smith: Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Jaclyn Engel: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Danielle Marie Muscat: Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Sian K. Smith: University of Bath, School of Management, Bath, Somerset, UK
Julien Mancini: Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d’Azu, France
Lilisbeth Perestelo-Pérez: Evaluation Unit (SESCS), Canary Islands Health Service (SCS), REDISSEC, Tenerife, Spain
Glyn Elwyn: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
A. James O’Malley: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
JoAnna K. Leyenaar: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
Olivia Mac: Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Tamara Cadet: School of Social Work, Simmons University, Boston, MA, USA
Anik Giguere: Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
Ashley J. Housten: Washington University School of Medicine, St Louis, MO, USA
Aisha Langford: New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA
Kirsten McCaffery: Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Marie-Anne Durand: The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA

Medical Decision Making, 2021, vol. 41, issue 7, 870-896

Abstract: Background The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. Purpose To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. Data Sources MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. Study Selection Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. Data Extraction Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. Data Synthesis Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I 2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I 2 = 0%]). PtDAs reduced decisional conflict (mean difference = −9.59; 95% CI −18.94, −0.24 [I 2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I 2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI −0.22, 0.26 [I 2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. Limitations Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. Conclusions PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective. Highlights Systematic review and meta-analysis of patient decision aids and other shared decision-making (SDM) interventions for disadvantaged populations. Patient decision aids and other SDM interventions improve patient-reported outcomes for disadvantaged populations. There was no evidence on what intervention characteristics best supported disadvantaged populations.

Keywords: health disparities; health literacy; patient decision aids; patient-provider communication; shared decision making (search for similar items in EconPapers)
Date: 2021
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:7:p:870-896

DOI: 10.1177/0272989X211020317

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