The Effect of Patient Decision Aid Attributes on Patient Outcomes: A Network Meta-Analysis of a Systematic Review

Dawn Stacey, Meg Carley, Janet Gunderson, Shu-Ching Hsieh, Shannon E. Kelly, Krystina B. Lewis, Maureen Smith, Robert J. Volk and George Wells
Additional contact information
Dawn Stacey: University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
Meg Carley: Ottawa Hospital Research Institute, Ottawa, Canada
Janet Gunderson: Cochrane Consumer, Glaslyn, Saskatchewan, Canada
Shu-Ching Hsieh: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
Shannon E. Kelly: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
Krystina B. Lewis: University of Ottawa, Ottawa, Canada
Maureen Smith: Cochrane Consumer, Ottawa, Canada
Robert J. Volk: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
George Wells: Cardiovascular Research Methods Centre, University of Ottawa Heart Institute and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

Medical Decision Making, 2025, vol. 45, issue 4, 437-448

Abstract: Background Patient decision aids (PtDAs) are effective interventions to help people participate in health care decisions. Although there are quality standards, PtDAs are complex interventions with variability in their attributes. Purpose To determine and compare the effects of PtDA attributes (e.g., content elements, delivery timing, development) on primary outcomes for adults facing health care decisions. Data Sources A systematic review of randomized controlled trials (RCTs) comparing PtDAs to usual care. Study Selection Eligible RCTs measured at least 1 primary outcome: informed values choice, knowledge, accurate risk perception, decisional conflict subscales, and undecided. Data Analysis A network meta-analysis evaluated direct and indirect effects of PtDA attributes on primary outcomes. Data Synthesis Of 209 RCTs, 149 reported eligible outcomes. There was no difference in outcomes for PtDAs using implicit compared with explicit values clarification. Compared with PtDAs with probabilities, PtDAs without probabilities were associated with poorer patient knowledge (mean difference [MD] −3.86; 95% credible interval [CrI] −7.67, −0.03); there were no difference for other outcomes. There was no difference in outcomes when PtDAs presented information in ways that decrease cognitive demand and mixed results when PtDAs used strategies to enhance communication. Compared with PtDAs delivered in preparation for consultations, PtDAs used during consultations were associated with poorer knowledge (MD −4.34; 95% CrI −7.24, −1.43) and patients feeling more uninformed (MD 5.07; 95% CrI 1.06, 9.11). Involving patients in PtDA development was associated with greater knowledge (MD 6.56; 95% CrI 1.10, 12.03) compared with involving health care professionals alone. Limitations There were no direct comparisons between PtDAs with/without attributes. Conclusions Improvements in knowledge were influenced by some PtDA content elements, using PtDA content before the consultation, and involving patients in development. There were few or no differences on other outcomes. Highlights This is the first known network meta-analysis conducted to determine the contributions of the different attributes of patient decision aids (PtDAs) on patient outcomes. There was no difference in outcomes when PtDAs used implicit compared with explicit values clarification. There were greater improvements in knowledge when PtDAs included information on probabilities, PtDAs were used in preparation for the consultation or development included patients on the research team. There was no difference in outcomes when PtDAs presented information in ways that decrease cognitive demand and mixed results when PtDAs used strategies to enhance communication.

Keywords: patient decision aid; network meta-analysis; systematic review; shared decision making interventions (search for similar items in EconPapers)
Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X251318640 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:45:y:2025:i:4:p:437-448

DOI: 10.1177/0272989X251318640

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().