Decision aids for people facing health treatment or screening decisions

O’Connor, Annette M.; Bennett, Carol; Stacey, Dawn; Barry, Michael J.; Col, Nananda F.; Eden, Karen; Entwistle, Vikki; Fiset, Valerie; Holmes‐Rovner, Margaret; Khangura, Sara D.; Llewellyn‐Thomas, Hilary A.; Rovner, David R.

doi:10.1002/14651858.cd001431.pub2

Cited by 757 publications

(903 citation statements)

References 144 publications

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“…Decision aids can help to educate patients and to encourage shared decision making, a process whereby patients discuss treatment options and decisions with their doctors [11,12]. A growing number of decision aids are being provided online as adults are using the Internet in greater numbers to access health information [13,14].…”

Section: Introductionmentioning

confidence: 99%

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

Tomko

Davis

Ludin

et al. 2014

Behav. Med. Pract. Policy Res.

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Informed decision-making tools are recommended for men considering prostate cancer screening. We evaluated the extent to which use of an interactive, web-based decision aid was associated with decisional and screening outcomes. Participants (N=253) were 57 (7.0)years old and completed telephone interviews at baseline, 1month, and 13months post-baseline. Tracking software captured minutes spent on the website (median=33.9), sections viewed (median=4.0/5.0), testimonials viewed (median=4.0/6.0), and values clarification tool (VCT) use (77.3%). In multivariable analyses, all four website use variables were positively associated with increased knowledge (p's<0.05). Complete VCT use and number of informational sections were positively associated with greater decisional satisfaction (p's<0.05). Decisional conflict and screening behavior were not associated with measures of website use. Increased use of informational content and interactive elements were related to improved knowledge and satisfaction. Methods to increase utilization of interactive website components may improve informed decision-making outcomes.

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Section: Introductionmentioning

confidence: 99%

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

Tomko

Davis

Ludin

et al. 2014

Behav. Med. Pract. Policy Res.

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“…[124][125][126][127] The current volume-based, fee-for-service system is often cited as a barrier to SDM implementation for individual providers, 128 and low-resource organizations, often those serving predominantly minority populations, may be affected most acutely. Negotiations with payers to allow reimbursement for SDM activities could ease challenges of time, scheduling, and staffing (driver 1) and provide the capital to procure space and technology to support SDM (drivers 2 and 4).…”

Section: Financial Incentivesmentioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…They improve patients' knowledge regarding treatment options, reduce decisional conflict, and stimulate patients to take an active role in decision-making [5,23,27]. They increase accurate perceptions of treatment risk and improve congruence between a patient's values and the chosen option [27]. They are tools designed to prepare people to participate in making specific and deliberate choices among treatment options in ways that they prefer.…”

Section: Introductionmentioning

confidence: 99%

“…They are tools designed to prepare people to participate in making specific and deliberate choices among treatment options in ways that they prefer. They also have been shown to increase use of evidence-based treatments [27]. In a pilot study [37], a decision aid for knee OA and a personalized arthritis report immediately improved willingness for TKA among black veterans.…”

Section: Introductionmentioning

confidence: 99%

Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

Vina

Richardson

Medvedeva

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA. Questions/purposes We asked: (1) Does a patient-centered intervention consisting of a decision aid for knee OA and motivational interviewing improve the proportion of referrals of blacks with knee OA to orthopaedic surgery? (2) Does the intervention increase patients' willingness to undergo TKA? Methods Adults who self-identified as black who were at least 50 years old with moderate to severe knee OA were enrolled from urban primary care clinics in a two-group randomized, controlled trial. A total of 1253 patients were screened for eligibility, and 760 were excluded for not meeting inclusion criteria, declining to participate, or other reasons. Four hundred ninety-three patients were randomized and completed the intervention; three had missing referral data at followup. The mean age of the patients was 61 years, and 51% were women. The majority had an annual household income less than USD 15,000. Participants in the treatment group were shown a decision-aid video and had a brief session with a trained counselor in motivational interviewing.

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Decision aids for people facing health treatment or screening decisions

Abstract: , D. (2009). Decision aids for people facing health treatment or screening decisions (Review). Cochrane Database of Systematic Reviews, (3), [CD001431].

Cited by 757 publications

References 144 publications

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

Decisional outcomes following use of an interactive web-based decision aid for prostate cancer screening

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

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