Decision aids

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

Contents

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. [1] 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. [1] Decision aids can be of any type but are most commonly pamphlets, videos, or web-based tools. [2] Decision aids support the process of constructing preferences and eventual decision making, appropriate to their individual situation. [1]

Decision aids are distinct from traditional educational materials as they focus on presenting various alternatives, detailing the associated risks and benefits, including explicit probabilities, and tailoring information to individual patients [3] To support shared decision-making, evidence-based patient decision aids (ptDAs) have been created. [4]

Shared Decision Making

Shared Decision-Making is a collaborative approach where patients and healthcare providers come together to discuss and choose treatment options. This process values patient preferences and individual values, making sure that patients are actively involved in their care rather than just receiving it passively. By having open conversations about available options, healthcare providers can customize treatments to better match what is important to the patient, which can enhance both satisfaction and overall health outcomes. [5] https://www.england.nhs.uk/personalisedcare/shared-decision-making/decision-support-tools/

The Interprofessional Shared Decision Making Model (IP-SDM) expands the concept of shared decision-making beyond the traditional patient-provider relationship by addressing three levels within the healthcare system:

  1. Micro Level (Individual): At this level, the patient faces a health issue that requires a decision. Together with their healthcare team and family members, the patient engages in a structured process to make informed, preference-sensitive choices, ensuring that everyone involved reaches a mutual understanding throughout the decision-making process.
  2. Meso Level (Healthcare Teams): This level focuses on the healthcare professionals involved in the decision-making process, highlighting two key roles: the initiator of the shared decision-making process and the decision coach.
  3. Macro Level (Broader Policies and Social Contexts): This level recognizes that the interprofessional approach to shared decision-making in clinical settings is influenced by wider healthcare system https://decisionaid.ohri.ca/ip-sdm.html.

Usage

There are numerous ways in which decision aids can be used. [1] 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. [6]

Efficacy

Decision aids provide people with a greater understanding of their medical treatment options and empower people to participate in their own health decision making. [2] Supplementing patient-education consultations with decision tools improves people's knowledge about the risks and benefits of a procedure or medication and may help them make decisions that are in line with their personal values. [2]

No adverse effects have been identified. [2]

It is not clear what type of decision aid for patients is cost-effective. [2] It is also not clear what impact the use of clinical decision aid systems that assist people who face healthcare treatments or screening decisions may have on the overall healthcare system. [2] It is not known if decision aids are helpful for people who are not strong readers. [2]

Producers

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 [7] to produce its decision aids. [8]

While researchers and health care facilities have different approaches to producing these decision aids, engaging patients in the process appears to have benefits. Results of a systematic review of the literature found that involving users in the design and development of these tools, from the needs assessment, through reviewing the content during development, and into prototyping, piloting, and usability testing, benefits the overall process. [9]

Standards

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. [10] 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, [11] and, more recently, an assessment instrument (IPDAS) [12] 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. [13] 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. [14]

Related Research Articles

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.

<span class="mw-page-title-main">Health informatics</span> Computational approaches to health care

Health informatics is the study and implementation of computer structures and algorithms to improve communication, understanding, and management of medical information. It can be viewed as a branch of engineering and applied science.

<span class="mw-page-title-main">Quality-adjusted life year</span> Measure of disease burden

The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0 (dead). QALYs can be used to inform health insurance coverage determinations, treatment decisions, to evaluate programs, and to set priorities for future programs.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

A clinical decision support system (CDSS) is a health information technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to help health and health care. CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools. CDSSs constitute a major topic in artificial intelligence in medicine.

In medicine, patient compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication also plays a major role.

Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Based on a 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands, the use of electronic health records (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.

Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.

Patient participation is a trend that arose in answer to medical paternalism. Informed consent is a process where patients make decisions informed by the advice of medical professionals.

Shared decision-making in medicine (SDM) is a process in which both the patient and physician contribute to the medical decision-making process and agree on treatment decisions. Health care providers explain treatments and alternatives to patients and help them choose the treatment option that best aligns with their preferences as well as their unique cultural and personal beliefs.

<span class="mw-page-title-main">Glyn Elwyn</span> Physician-researcher and professor

Glyn Elwyn is a professor and physician-researcher at The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA, where he directs the Patient Engagement Research Program. He also leads The Preference Laboratory, an international interdisciplinary team at The Dartmouth Institute, examining the implementation of shared decision making into clinical settings, using tools and measures such as collaboRATE, a patient experience measure of shared decision making, and Observer OPTION, a process measure for shared decision making for use on recorded data.

CommonGround is a Web app that helps mental health clients identify treatment preferences and effectively communicate them to clinicians. CommonGround Software supports shared-decision making in behavioral health. It brings the voice of the individual to the center of the care team. In this way, the team can focus on "what matters to you" rather than "what's the matter with you?"

Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care.

Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

Option Grid is the name for a tool for patients and providers to use together when they are discussing and deciding what best to do about possible options, either treatments or tests. The grid is published in the form of a summary table to enable comparisons between multiple potential treatments or options. The grids do this by using questions that patients frequently ask (FAQs), and are designed for use in face-to-face clinical encounters or to be given to patients to read for a few minutes, ahead of a conversation with a provider.

<span class="mw-page-title-main">Treatment decision support</span>

Treatment decision support consists of the tools and processes used to enhance medical patients’ healthcare decision-making. The term differs from clinicaldecision support, in that clinical decision support tools are aimed at medical professionals, while treatment decision support tools empower the people who will receive the treatments. This service may be delivered at the site of healthcare services, or as an employee benefit through third-party providers.

Annette Marie Cormier O'Connor is a distinguished professor and professor emerita at the School of Nursing at the University of Ottawa and a fellow of the Royal Society of Canada and Canadian Academy of Health Sciences. She is a Tier 1 Canada Research Chair in Healthcare Consumer Decision Support and was awarded the Order of Canada in 2018.

Lisa J. M. Caldon is a British professor and clinical lecturer specialising in oncology. In her 20 year career, Caldon has published some 20 papers in the field of medicine. These have appeared in some of the top medical and peer-reviewed journals in Britain and abroad, including Medical Education, the European Journal of Cancer, the British Journal of Surgery, Patient Education and Counseling, Psycho-Oncology, Future Oncology, BMC Medical Informatics and Decision Making, and The Lancet Oncology. Caldon has worked at The University of Sheffield and with Cancer Research UK.

References

  1. 1 2 3 4 Elwyn G, Frosch D, Volandes A, Edwards A, Montori V (2009). "Investing in deliberation: defining and developing decision support interventions for people facing difficult health decisions". White Paper Series. Gaithersberg, Maryland, USA: John M Eisenberg Center for Clinical Decisions and Communication. Archived from the original on 2016-09-23.{{cite journal}}: Cite journal requires |journal= (help)
  2. 1 2 3 4 5 6 7 Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID (2024-01-29). "Decision aids for people facing health treatment or screening decisions". The Cochrane Database of Systematic Reviews. 1 (1): CD001431. doi:10.1002/14651858.CD001431.pub6. ISSN   1469-493X. PMC  10823577. PMID   38284415.
  3. ↑ O'Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, Mcpherson R, Drake E, Hopman W, Mackenzie T (August 1998). "Randomized Trial of a Portable, Self-administered Decision Aid for Postmenopausal Women Considering Long-term Preventive Hormone Therapy". Medical Decision Making. 18 (3): 295–303. doi:10.1177/0272989x9801800307. ISSN   0272-989X.
  4. ↑ Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L (2017-04-12). "Decision aids for people facing health treatment or screening decisions". Cochrane Database of Systematic Reviews. 2017 (4). doi:10.1002/14651858.cd001431.pub5. ISSN   1465-1858.
  5. ↑ "Conceptual Frameworks - Patient Decision Aids - Ottawa Hospital Research Institute". decisionaid.ohri.ca. Retrieved 2024-09-09.
  6. ↑ Gravel K, Légaré F, Graham ID (2006). "Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions". Implement Sci. 1: 16. doi: 10.1186/1748-5908-1-16 . PMC   1586024 . PMID   16899124.
  7. ↑ "International Patient Decision Aids Standards (IPDAS) Collaboration". ipdas.ohri.ca. Retrieved 2016-09-19.
  8. ↑ "Patient Decision Aids | AHRQ Effective Health Care Program". www.effectivehealthcare.ahrq.gov. Archived from the original on 2016-09-18. Retrieved 2016-09-19.
  9. ↑ Vaisson G, Provencher T, Dugas M, Trottier MÈ, Chipenda Dansokho S, Colquhoun H, Fagerlin A, Giguere AM, Hakim H, Haslett L, Hoffman AS (2021). "User Involvement in the Design and Development of Patient Decision Aids and Other Personal Health Tools: A Systematic Review". Medical Decision Making. 41 (3): 261–274. doi: 10.1177/0272989X20984134 . ISSN   0272-989X. PMID   33655791.
  10. ↑ O'Connor AM, Wennberg JE, Legare F, et al. (2007). "Toward the 'tipping point': decision aids and informed patient choice". Health Aff (Millwood). 26 (3): 716–25. doi:10.1377/hlthaff.26.3.716. PMID   17485749.
  11. ↑ Elwyn G, O'Connor A, Stacey D, et al. (August 2006). "Developing a quality criteria framework for patient decision aids: online international Delphi consensus process". BMJ. 333 (7565): 417–0. doi:10.1136/bmj.38926.629329.AE. PMC   1553508 . PMID   16908462.
  12. ↑ Elwyn G, O'Connor AM, Bennett C, et al. (2009). "Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi)". PLOS ONE. 4 (3): e4705. Bibcode:2009PLoSO...4.4705E. doi: 10.1371/journal.pone.0004705 . PMC   2649534 . PMID   19259269.
  13. ↑ "BMC Medical Informatics and Decision Making". BMC Medical Informatics and Decision Making. Retrieved 2016-09-19.
  14. ↑ Joseph-Williams N, Newcombe R, Politi M, Durand MA, Sivell S, Stacey D, O'Connor A, Volk RJ, Edwards A (2014-08-01). "Toward Minimum Standards for Certifying Patient Decision Aids: A Modified Delphi Consensus Process". Medical Decision Making. 34 (6): 699–710. doi:10.1177/0272989X13501721. ISSN   1552-681X. PMID   23963501. S2CID   3815932.
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