Establishing the effectiveness of patient decision aids: key constructs and measurement instruments

Abstract

BackgroundEstablishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness.MethodsThis updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration’s review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required.ResultsThe 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs.ConclusionsEvidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.

Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial

“…7 Decision aids are provided where there is no obviously right or wrong option, so the focus in evaluating them should not be on the option selected 19 but rather on decision quality defined in terms of knowledge and values-choice agreement. 20 Screening rates may not reflect people"s informed decisions if coercion or obstacles are present. 12 In this study, therefore, our key question was whether evidence-based, consumer-friendly information on overdetection improves the level of informed choice about screening in a community sample of women around the target age for starting breast screening in Australia.…”

Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence

“…Decision quality reflects the extent to which patients are informed and understand their options, and importantly, that decisions made reflect their goals and preferences. 26 With this transition in medical education, providers will likely benefit from learning new skills to improve communication with patients during visits. There are also resources available to support practicing physicians, such as ManagingYourMeds (available from http://managingyourmeds.org), which lists a number of promising medication adherence practices.…”

Assisting parents of children with autism to make intervention decisions by improving their health literacy about evidence

“…Kryworuchko, Stacey, Bennett & Graham (2008) concluded that "selecting relevant and high quality outcome measures remains challenging and is an important area for further research in the field of shared decision making" (p.497). Sepucha et al (2013) reviewed 86 studies that utilised instruments that aimed to measure decision making processes and/ or decision quality constructs specific to decision aids. They found that 17 different measurements were used to measure decision making process constructs in these studies, with the Decisional Conflict Scale (DCS) being the most commonly used (n=47).…”

“…They found that not one of the tools in their study measured all key decision making processes and constructs which included decision making process constructs (recognise decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with healthcare provider, and be involved in decisions), and decision quality constructs (knowledge, realistic expectations, values-choice agreement). Sepucha et al (2013) found that there was no consensus or standardisation of measurement for either the decision making process or decision quality constructs. They concluded that more work was required to develop and evaluate decision aid measurement instruments, and further exploration of theoretical issues to advance future research was urgently required.…”