Treatment decision aids are unlikely to cut healthcare costs

The growing emphasis on patient centered care is increasing the demand on physicians’ time and effort to engage patients and their families in decision making regarding treatment. At the same time, the clinical encounter is becoming more challenging because evaluative testing strategies and decisions about disease management are increasingly complex.1 In this context, growing interest in decision aids is motivated by expectations that they can increase the efficiency and effectiveness of decision making regarding treatment and improve patients’ experiences. Indeed, there is compelling evidence that decision aids can increase a patient’s knowledge, satisfaction with the clinical encounter, and engagement with clinicians.2 More recently, decision aids have been advocated as a tool for dealing with the growing concerns about overtreatment and cost inflation.3 The argument is anchored on the assumption that a better informed and more engaged patient would be less likely to choose a management plan as extensive as that recommended by their clinician. The linked paper by Walsh and colleagues (doi:10.1136/bmj.g188) reviews the suggestion that decision aids could reduce costs,4 which has permeated policy statements and commentaries on both sides …