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]

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. [3]

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 [4] to produce its decision aids. [5]

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. [6]

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. [7] 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, [8] and, more recently, an assessment instrument (IPDAS) [9] 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. [10] 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. [11]

Related Research Articles

Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual 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">Electronic health record</span> Digital collection of patient and population electronically stored health information

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

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.

Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients under his or her care.

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.

<span class="mw-page-title-main">Systematic review</span> Comprehensive review of research literature using systematic methods

A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based conclusion. For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine.

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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.

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<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.

The PICO process is a mnemonic used in evidence-based practice to frame and answer a clinical or health care related question, though it is also argued that PICO "can be used universally for every scientific endeavour in any discipline with all study designs". The PICO framework is also used to develop literature search strategies, for instance in systematic reviews.

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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. ↑ 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.
  4. ↑ "International Patient Decision Aids Standards (IPDAS) Collaboration". ipdas.ohri.ca. Retrieved 2016-09-19.
  5. ↑ "Patient Decision Aids | AHRQ Effective Health Care Program". www.effectivehealthcare.ahrq.gov. Archived from the original on 2016-09-18. Retrieved 2016-09-19.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ "BMC Medical Informatics and Decision Making". BMC Medical Informatics and Decision Making. Retrieved 2016-09-19.
  11. ↑ 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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