Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

Abstract

BackgroundClinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes.MethodsWe searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach.ResultsTwenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors.ConclusionDecision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.

Tempo de espera e duração da consulta médica na região metropolitana de Manaus, Brasil: estudo transversal de base populacional, 2015*

“…18 Tools to support joint decision making have shown themselves to be effective in terms of improving the contents of medical consultations and doctors' satisfaction, without increasing consultation length. 11 In this study, patients who had health insurance spent less time waiting for their consultation. This finding is similar to that of a cross-sectional study that analyzed 21 million outpatient consultations by patients using the Medicaid system in the United States in 2013, which also found longer waiting times for patients who did not have private health care insurance, compared to patients who did have health insurance.…”

“…10 The contents of a medical consultation appear to play an important role with regard to both patient and doctor satisfaction. 11 Population-based studies evaluating waiting time and length of medical consultations in Brazil are scarce, especially in the country's Northern region. The objective of this study was to analyze waiting time and medical consultation length and associated factors in the Manaus metropolitan region in 2015.…”

Pregnant pause: should we screen for sleep disordered breathing in pregnancy?

“…For others the psychological, financial or practical consequences of diagnosis or intervention may be of more concern. Therefore, when dealing with uncertainty clinicians should strive for shared decision-making approaches [63]. As well as reducing individual choice, there is the potential for the labelling of pregnant women with a condition to have a detrimental impact on maternal wellbeing.…”

Implementation and Sustainability Factors of Two Early-Stage Breast Cancer Conversation Aids in Diverse Practices

“…Conversation aids help patients compare treatment options using evidence-based information to support them and their families in making a decision that is aligned with their preferences and values. [1][2][3] However, sustained implementation of these conversation aids in clinical care is complex. [4][5][6][7][8][9][10][11][12][13] Clinical barriers can include a lack of training on the conversation aids, clinician indifference on using them, lack of trust in the content of the conversation aids, and possible disruption of established clinic behaviors and work ows.…”