442 Decision aids helpful for treatment or screening decisions

October 31, 2014

written by Brian R McAvoy

Clinical question
How effective are decision aids for people facing treatment or screening decisions?

Bottom line
When patients used decision aids, they improved their knowledge of the options, felt more informed and more clear about what mattered most to them (both with high-quality evidence), had more accurate expectations of the possible benefits and harms of their options, and participated more in decision making (both with moderate-quality evidence). Patients who used decision aids that included an exercise to help them clarify what mattered most to them were more likely to reach decisions consistent with their values. Decision aids improved communication between patients and their health practitioner, and had a variable effect on consultation length. They reduced the number of patients choosing prostate-specific antigen testing and discretionary surgery, and had no apparent adverse effects on health outcomes or satisfaction.

This systematic review was limited by inadequate power to detect important differences in effectiveness in subgroups and in the wide variability in the decision contexts, the elements within the patient decision aid, the type of comparison interventions, the targeted outcomes and the evaluation procedures. Several of the outcomes demonstrated statistically significant heterogeneity.

Decision aids can be used when there is more than one reasonable option, when no option has a clear advantage in terms of health outcomes and when each option has benefits and harms that patients may value differently. Decision aids may be pamphlets, videos or web-based tools. They make the decision explicit, describe the options available and help people to understand these options, as well as their possible benefits and harms.

Cochrane Systematic Review
Stacey D et al. Decision aids for people facing health treatment or screening decisions. Cochrane Reviews, 2014, Issue 1. Art. No.: CD011431.DOI: 10.1002/14651858. CD011431.pub4. This review contains 115 studies involving 34,444 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.