Decision aids for patients facing health treatment or screening decisions: systematic review

BMJ 1999;319:731-734 ( 18 September )

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Decision aids for patients facing health treatment or screening decisions: systematic review

Annette M O'Connor, professor, ^a Alaa Rostom, gastroenterologist, ^a Valerie Fiset, clinical nurse specialist, ^b Jacqueline Tetroe, research associate, ^a Vikki Entwistle, senior research fellow, ^c Hilary Llewellyn-Thomas, professor, ^d Margaret Holmes-Rovner, professor, ^e Michael Barry, chief, general medicine unit, ^f Jean Jones, consumer health advocate. ^g

^a University of Ottawa School of Nursing and Faculty of Medicine, Loeb Health Research Institute Clinical Epidemiology Unit, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada K1Y 4E9, ^b Sisters of Charity of Ottawa Health Services, Ottawa, Ontario, Canada, ^c Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, ^d University of Toronto, Institute for Clinical Evaluative Sciences, North York, Ontario, Canada, ^e Department of Medicine, Michigan State University, East Lansing MI, USA, ^f General Medicine Unit, Massachusetts General Hospital, Boston, MA, USA, ^g Dundas, Ontario, Canada

Correspondence to: A O'Connor aoconnor{at}LRI.CA

Objective: To conduct a systematic review of randomisedtrials of patient decision aids in improving decision making andoutcomes.
Design: We included randomised trials of interventionsproviding structured, detailed, and specific information on treatmentor screening options and outcomes to aid decision making. Tworeviewers independently screened and extracted data on severalevaluation criteria. Results were pooled by using weighted meandifferences and relativerisks.
Results: 17 studies met the inclusion criteria. Comparedwith the controls, decision aids produced higher knowledge scores(weighted mean difference=19/100, 95% confidence interval 14 to25); lower decisional conflict scores (weighted mean difference= $-$ 0.3/5, $-$ 0.4 to $-$ 0.1); more active patient participation in decision making(relative risk = 2.27, 95% confidence interval 1.3 to 4); andno differences in anxiety, satisfaction with decisions (weightedmean difference=0.6/100, $-$ 3 to 4), or satisfaction with the decisionmaking process (2/100, $-$ 3 to 7). Decision aids had a variable effecton decisions. When complex decision aids were compared with simplerversions, they were better at reducing decisional conflict, improvedknowledge marginally, but did not affectsatisfaction.
Conclusions: Decision aids improve knowledge, reduce decisionalconflict, and stimulate patients to be more active in decisionmaking without increasing their anxiety. Decision aids have littleeffect on satisfaction and a variable effect on decisions. Theeffects on outcomes of decisions (persistence with choice, qualityof life) remainuncertain.

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BMJ 1999 319: 0. [Full Text]

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