Decision aids that facilitate elements of shared decision making in chronic illnesses: a systematic review

Abstract

Background Shared decision making (SDM) is a patient-centered approach in which clinicians and patients work together to find and choose the best course of action for each patient’s particular situation. Six SDM key elements can be identified: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences, and making the decision. The International Patient Decision Aid Standards (IPDAS) require that a decision aid (DA) support these key elements. Yet, the extent to which DAs support these six key SDM elements and how this relates to their impact remain unknown. Methods We searched bibliographic databases (from inception until November 2017), reference lists of included studies, trial registries, and experts for randomized controlled trials of DAs in patients with cardiovascular, or chronic respiratory conditions or diabetes. Reviewers worked in duplicate and independently selected studies for inclusion, extracted trial, and DA characteristics, and evaluated the quality of each trial. Results DAs most commonly clarified options (20 of 20; 100%) and discussed their harms and benefits (18 of 20; 90%; unclear in two DAs); all six elements were clearly supported in 4 DAs (20%). We found no association between the presence of these elements and SDM outcomes. Conclusions DAs for selected chronic conditions are mostly designed to transfer information about options and their harms and benefits. The extent to which their support of SDM key elements relates to their impact on SDM outcomes could not be ascertained. Systematic review registration PROSPERO registration number: CRD42016050320 . Electronic supplementary material The online version of this article (10.1186/s13643-019-1034-4) contains supplementary material, which is available to authorized users.

Content and system development of a digital patient-provider communication tool to support shared decision making in chronic health care: InvolveMe

“…SDM-tools have been shown to improve patient knowledge, help patients to become more aware of what matters most to them, and help patients to feel more involved in the decision making process [19]. Despite the fact that symptom management is an important and integral part of chronic health care, only few existing SDM-tools include symptom management [19,20]. Furthermore, a recent systematic review examining SDM tools in chronic health conditions revealed that the included tools were mostly designed to "transfer information" about options and the harms and benefits of these [20].…”

“…Despite the fact that symptom management is an important and integral part of chronic health care, only few existing SDM-tools include symptom management [19,20]. Furthermore, a recent systematic review examining SDM tools in chronic health conditions revealed that the included tools were mostly designed to "transfer information" about options and the harms and benefits of these [20]. Suggestions have been made, stating that SDM needs to focus on creating patient-provider interactions promoting communication and care, not just on offering information and choice [17,21].…”

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

“…Utilization of decisions aids for decision making depends largely on how the materials were prepared, the nature of contents and how they are utilized. (32) Response of participants indicated aids available in the clinic to be a good source of knowledge however it is di cult to link their use and shared decision making. This coheres to studies, which have portrayed that decision aids are preferred as they are knowledge tools that may facilitate shared decision-making (33,34).…”

Exercise capacity is associated with hospital readmission among patients with diabetes

“…Good patient–clinician health communication guided by the use of shared decision making (SDM) approach during and after hospitalization has the potential to help patients increase their physical activity. SDM studies in general, 25 26 and particularly in diabetes, 27–29 indicate promising engagement outcomes for treatment uptake. However, most SDM studies in diabetes targeted treatment-related decisions, and tools for motivating patient engagement in physical activity are lacking.…”