Decision aids

Decision aids are interventions or tools designed to facilitate shared decision making and patient participation in health care decisions.

Decision support interventions help people think about choices they face; they describe where and why choice exists; and they provide information about options, including, where reasonable, the option of taking no action. These interventions aim to help people to deliberate, independently or in collaboration with others, about options by considering relevant attributes to help them forecast how they might feel about short, intermediate and long-term outcomes which have relevant consequences. Decision aids can be of any type but are most commonly pamphlets, videos, or web-based tools. Decision aids support the process of constructing preferences and eventual decision making, appropriate to their individual situation.

There are numerous ways in which decision aids can be used. They can be brief enough to be used during a clinical encounter or they can have sufficient content to be used before or after clinical encounters. Although decision aids have been available since the early 1980s, evidence suggests that they are not well integrated into routine practice.

A Cochrane review came to the findings that when patients use decision aids they:

Exposure to decision aids demonstrated reduced rates of elective invasive surgery in favour of conservative options. More detailed decision aids are better than simple ones for improving knowledge and lowering decisional conflict related to feeling uninformed and unclear about personal values.

There are also many active research groups in the field, including the University of Ottawa, Dartmouth College, Cardiff University and Hamburg; the Agency for Healthcare Research and Quality uses the IPDAS standards to produce its decision aids.

There has been an increase in use of decision support and a global interest in developing these interventions among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of testing and evaluation. The International Patient Decision Aids Standards (IPDAS) Collaboration has published a checklist, and, more recently, an assessment instrument (IPDAS) to evaluate the quality of decision support interventions. In its November 2013 issue, BMC Medical Informatics and Decision Making published a supplement that described the 10-year evolution of the IPDAS Collaboration and 12 core dimensions for assessing the quality of patient decision aids. While specifying minimum standards for patient decision support interventions is a feasible development, it is unclear whether the minimum standards can be applied to interventions designed for use within clinical encounters and to those that target screening and diagnostic tests.

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