BMJ  2006;333:417 (26 August), doi:10.1136/bmj.38926.629329.AE (published 14 August 2006)

Research

Developing a quality criteria framework for patient decision aids: online international Delphi consensus process

¹ Department of General Practice, Centre for Health Sciences Research, Cardiff University, Cardiff CF14 4YS, ² University of Ottawa and Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada K1Y 4E9, ³ School of Nursing, University of Ottawa, Ottawa, ON, Canada K1H 8M5, ⁴ Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098-3915, USA, ⁵ Picker Institute Europe, King's Mead House, Oxford OX1 1RX, ⁶ Newcastle upon Tyne Medical School, School of Population and Health Sciences, Newcastle upon Tyne NE2 4HH, ⁷ Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia, ⁸ Medical Psychology Research Unit, School of Psychology, University of Sydney, ⁹ Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA, ¹⁰ HSR&D Center of Excellence, VA Ann Arbor Healthcare System, USA, ¹¹ Public Health Resource Unit, Oxford OX4 2GX, ¹² Social Dimensions of Health Institute, University of Dundee, Dundee DD1 4HJ, ¹³ Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada, ¹⁴ Center for Ethics, Michigan State University, East Lansing, MI 48824, USA, ¹⁵ Center for the Evaluative Clinical Sciences, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA, ¹⁶ GRESAC, Centre Léon Bérard, 69008 Lyon, France, ¹⁷ Rikshospitalet Radiumhospitalet, Oslo, Norway, ¹⁸ Acadvent Ltd, 171 Gower Road, Swansea, ¹⁹ Department of Medicine, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada

Abstract

Objective To develop a set of quality criteria for patient decision support technologies (decision aids).

Design and setting Two stage web based Delphi process using online rating process to enable international collaboration.

Participants Individuals from four stakeholder groups (researchers, practitioners, patients, policy makers) representing 14 countries reviewed evidence summaries and rated the importance of 80 criteria in 12 quality domains ona1to9 scale. Second round participants received feedback from the first round and repeated their assessment of the 80 criteria plus three new ones.

Main outcome measure Aggregate ratings for each criterion calculated using medians weighted to compensate for different numbers in stakeholder groups; criteria rated between 7 and 9 were retained.

Results 212 nominated people were invited to participate. Of those invited, 122 participated in the first round (77 researchers, 21 patients, 10 practitioners, 14 policy makers); 104/122 (85%) participated in the second round. 74 of 83 criteria were retained in the following domains: systematic development process (9/9 criteria); providing information about options (13/13); presenting probabilities (11/13); clarifying and expressing values (3/3); using patient stories (2/5); guiding/coaching (3/5); disclosing conflicts of interest (5/5); providing internet access (6/6); balanced presentation of options (3/3); using plain language (4/6); basing information on up to date evidence (7/7); and establishing effectiveness (8/8).

Conclusions Criteria were given the highest ratings where evidence existed, and these were retained. Gaps in research were highlighted. Developers, users, and purchasers of patient decision aids now have a checklist for appraising quality. An instrument for measuring quality of decision aids is being developed.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Patient consent—decision or assumption?

Glyn Elwyn
BMJ 2008 336: 1259-1260. [Extract] [Full Text] [PDF]

Improving shared decision making in osteoarthritis

Dawn Stacey, Gillian Hawker, Geoff Dervin, Ivan Tomek, Nan Cochran, Peter Tugwell, and Annette M O’Connor
BMJ 2008 336: 954-955. [Full Text] [PDF]

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

Alan A Montgomery, Clare L Emmett, Tom Fahey, Claire Jones, Ian Ricketts, Roshni R Patel, Tim J Peters, Deirdre J Murphy DiAMOND Study Group
BMJ 2007 334: 1305. [Abstract] [Full Text] [PDF]

Appraising quality of patient decision aids
BMJ 2006 333: 0. [Full Text]

Use of decision aids to support informed choices about screening

Alexandra Barratt, Lyndal Trevena, Heather M Davey, and Kirsten McCaffery
BMJ 2004 329: 507-510. [Extract] [Full Text] [PDF]

Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination

Anna Gagliardi and Alejandro R Jadad
BMJ 2002 324: 569-573. [Abstract] [Full Text] [PDF]

Prescribing indicators for UK general practice: Delphi consultation study

Stephen M Campbell, Judy A Cantrill, and Dave Roberts
BMJ 2000 321: 425-428. [Abstract] [Full Text] [PDF]

Better reporting of randomised controlled trials: the CONSORT statement

Douglas G Altman
BMJ 1996 313: 570-571. [Extract] [Full Text]

Qualitative Research: Consensus methods for medical and health services research

Jeremy Jones and Duncan Hunter
BMJ 1995 311: 376-380. [Extract] [Full Text]

What to do about halitosis

C Scully, S Porter, and J Greenman
BMJ 1994 308: 217-218. [Extract] [Full Text]

This article has been cited by other articles:

• Durand, M.A., Boivin, J., Elwyn, G. (2008). A review of decision support technologies for amniocentesis. Hum Reprod Update 0: dmn037v1-10 [Abstract] [Full text]  
• Colledge, A., Car, J., Donnelly, A., Majeed, A. (2008). Health information for patients: time to look beyond patient information leaflets. JRSM 101: 447-453 [Full text]  
• Legare, F., Dodin, S., Stacey, D., LeBlanc, A., Tapp, S. (2008). Patient decision aid on natural health products for menopausal symptoms: randomized controlled trial. Menopause Int 14: 105-110 [Abstract] [Full text]  
• Stacey, D., Samant, R., Bennett, C. (2008). Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation. CA Cancer J Clin 58: 293-304 [Abstract] [Full text]  
• Elwyn, G. (2008). Patient consent--decision or assumption?. BMJ 336: 1259-1260 [Full text]  
• Krones, T., Keller, H., Sonnichsen, A., Sadowski, E.-M., Baum, E., Wegscheider, K., Rochon, J., Donner-Banzhoff, N. (2008). Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial. Ann Fam Med 6: 218-227 [Abstract] [Full text]  
• Stacey, D., Hawker, G., Dervin, G., Tomek, I., Cochran, N., Tugwell, P., O'Connor, A. M (2008). Improving shared decision making in osteoarthritis. BMJ 336: 954-955 [Full text]  
• Boivin, A., Legare, F., Gagnon, M.-P. (2008). Competing norms: Canadian rural family physicians' perceptions of clinical practice guidelines and shared decision-making. J Health Serv Res Policy 13: 79-84 [Abstract] [Full text]  
• Wennberg, J. E., O'Connor, A. M., Collins, E. D., Weinstein, J. N. (2007). Extending The P4P Agenda, Part 1: How Medicare Can Improve Patient Decision Making And Reduce Unnecessary Care. Health Aff (Millwood) 26: 1564-1574 [Abstract] [Full text]  
• Holmes-Rovner, M., Nelson, W. L., Pignone, M., Elwyn, G., Rovner, D. R., O'Connor, A. M., Coulter, A., Correa-de-Araujo, R. (2007). Are Patient Decision Aids the Best Way to Improve Clinical Decision Making? Report of the IPDAS Symposium. Med Decis Making 27: 599-608 [Abstract]  
• O'Connor, A. M., Stacey, D., Barry, M. J., Col, N. F., Eden, K. B., Entwistle, V., Fiset, V., Holmes-Rovner, M., Khangura, S., Llewellyn-Thomas, H., Rovner, D. R. (2007). Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis. Med Decis Making 27: 554-574 [Abstract]  
• Winterbottom, A., Conner, M., Mooney, A., Bekker, H. L. (2007). Evaluating the quality of patient leaflets about renal replacement therapy across UK renal units. Nephrol Dial Transplant 22: 2291-2296 [Abstract] [Full text]  
• Montgomery, A. A, Emmett, C. L, Fahey, T., Jones, C., Ricketts, I., Patel, R. R, Peters, T. J, Murphy, D. J, DiAMOND Study Group, (2007). Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial. BMJ 334: 1305-1305 [Abstract] [Full text]  
• Weymiller, A. J., Montori, V. M., Jones, L. A., Gafni, A., Guyatt, G. H., Bryant, S. C., Christianson, T. J. H., Mullan, R. J., Smith, S. A. (2007). Helping Patients With Type 2 Diabetes Mellitus Make Treatment Decisions: Statin Choice Randomized Trial. Arch Intern Med 167: 1076-1082 [Abstract] [Full text]  
• O'Connor, A. M. (2007). Using decision aids to help patients navigate the "grey zone" of medical decision-making. CMAJ 176: 1597-1598 [Full text]  
• O'Connor, A. M., Wennberg, J. E., Legare, F., Llewellyn-Thomas, H. A., Moulton, B. W., Sepucha, K. R., Sodano, A. G., King, J. S. (2007). Toward The 'Tipping Point': Decision Aids And Informed Patient Choice. Health Aff (Millwood) 26: 716-725 [Abstract] [Full text]  
• Drife, J. (2007). Putting risk into context. The Obstetrician and Gynaecologist 9: 42-47 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Decision aids- overwhelming for the patient?

Deepa R Anijeet
bmj.com, 18 Aug 2006 [Full text]