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Decision aids to help people who are facing health treatment or screening decisions

Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC
Published Online: 
28 January 2014

Identifying and making a decision about the best health treatment or screening option can be difficult for patients. 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. This helps patients to consider the options from a personal view (e.g., how important the possible benefits and harms are to them) and helps them to participate with their health practitioner in making a decision.

The updated review, with searches updated in June 2012, includes 115 studies involving 34,444 participants. Findings show that when patients use decision aids they: a) improve their knowledge of the options (high-quality evidence); b) feel more informed and more clear about what matters most to them (high-quality evidence); c) have more accurate expectations of possible benefits and harms of their options (moderate-quality evidence); and d) participate more in decision making (moderate-quality evidence). Patients who used decision aids that included an exercise to help them clarify what matters most to them, were more likely to reach decisions that were consistent with their values. However, the quality of the evidence was moderate for this outcome, meaning that further research may change these findings. Decision aids reduce the number of patients choosing prostate specific antigen testing and elective surgery when patients consider other options. They have a variable effect on most other actual choices. Decision aids improve communication between patients and their health practitioner. More detailed decision aids are better than simple decision aids for improving people's knowledge and lowering decisional conflict related to feeling uninformed and unclear about their personal values. Decision aids do not worsen health outcomes and people using them are not less satisfied. More research is needed to evaluate adherence with the chosen option, the associated costs, use with patients who have more limited reading skills, and the level of detail needed in a decision aid.