Five shared decision-making tools in 5 months: use of rapid reviews to develop decision boxes for seniors living with dementia and their caregivers

Abstract

BackgroundDecision support tools build upon comprehensive and timely syntheses of literature. Rapid reviews may allow supporting their development by omitting certain components of traditional systematic reviews. We thus aimed to describe a rapid review approach underlying the development of decision support tools, i.e., five decision boxes (DB) for shared decision-making between seniors living with dementia, their caregivers, and healthcare providers.MethodWe included studies based on PICO questions (Participant, Intervention, Comparison, Outcome) describing each of the five specific decision. We gave priority to higher quality evidence (e.g., systematic reviews). For each DB, we first identified secondary sources of literature, namely, clinical summaries, clinical practice guidelines, and systematic reviews. After an initial extraction, we searched for primary studies in academic databases and grey literature to fill gaps in evidence. We extracted study designs, sample sizes, populations, and probabilities of benefits/harms of the health options. A single reviewer conducted the literature search and study selection. The data extracted by one reviewer was verified by a second experienced reviewer. Two reviewers assessed the quality of the evidence. We converted all probabilities into absolute risks for ease of understanding. Two to five experts validated the content of each DB. We conducted descriptive statistical analyses on the review processes and resources required.ResultsThe approach allowed screening of a limited number of references (range: 104 to 406/review). For each review, we included 15 to 26 studies, 2 to 10 health options, 11 to 62 health outcomes and we conducted 9 to 47 quality assessments. A team of ten reviewers with varying levels of expertise was supported at specific steps by an information specialist, a biostatistician, and a graphic designer. The time required to complete a rapid review varied from 7 to 31 weeks per review (mean ± SD, 19 ± 10 weeks). Data extraction required the most time (8 ± 6.8 weeks). The average estimated cost of a rapid review was C$11,646 (SD = C$10,914).ConclusionsThis approach enabled the development of clinical tools more rapidly than with a traditional systematic review. Future studies should evaluate the applicability of this approach to other teams/tools.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0446-2) contains supplementary material, which is available to authorized users.

User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study

“…On the basis of a published rapid-review approach [ 27 ], we synthesized evidence on the benefits and harms of the available options to maintain or improve cognitive functions in older adults with MCI. The evidence gathered was structured into a decision box template, which is in accordance with the international patient decision aid standards and has been described in earlier publications [ 8 , 9 ].…”

Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial

“…We will conduct a rapid literature review on the effects of eHealth interventions for supporting active involvement of patients with chronic diseases in their primary care team. For this purpose, we will follow the rapid review method suggested by Lawani et al 48 and consider the latest evidence on eHealth interventions for chronic diseases monitoring and care. We will consider the following ‘Problem, Intervention, Comparison, Outcomes’ elements: (P): three targeted chronic diseases (diabetes, high blood pressure, dyslipidaemia), alone or combined; (I) all eHealth interventions implemented in primary care and that directly involve patients (eg, electronic medical records (EMRs), patient diary, patient portal, specific computerised monitoring for a chronic disease and technological interventions focused on lifestyle modifications; (C): routine follow-up; (O): health outcomes specific to the disease (eg, glycosylated hemoglobin (HbA1c) for diabetes), generic health outcomes (eg, mortality, quality of life), patient outcomes (eg, involvement, personal efficacy) and practices and process outcomes (eg, test numbers, emergency visits, hospitalisations).…”

Modified Delphi survey for the evidence summarisation of patient decision aids: Study protocol

“…Additionally, the IPDAS impose some prerequisites on the evidence summarisation process on which the decision aid will be based. For example, IPDAS requires that the decision aid summarise the evidence regarding all health options available to a patient facing a specific health problem, and that decision aids present positive and negative features of each option with equal amount of details, among other specificities 18. Efforts to develop an agreed evidence summarisation process for PDAs should incorporate the substantial body of related evidence summarisation guidance previously developed by other groups, and notably for clinical practice guidelines previously mentioned 11…”