April 18, 2018 Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification. For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness

1. Theory and Knowledge of
Patient Decision Aids: the Evidence
Dawn Stacey RN, PhD
Research Chair, Knowledge Translation to Patients
Professor, University of Ottawa
Senior Scientist, Ottawa Hospital Research Institute
April 18, 2018
Boston
@d_stacey
.

2. Shared decision
making
(Legare et al., 2010; Makoul et al. 2006)
A process by which
decisions are made by the
patient and the clinician(s)
using the best available
evidence and patients
informed preferences.

3. – .. – ..
(Joseph-Williams et al 2014)
Knowledge
Knowledge about
disease/condition,
options, outcomes
&
Knowledge about
personal values and
preferences
Power
Perceived influence on
decision-making
encounter depends on
- permission to
participate
- confidence in own
knowledge
- self-efficacy in using
SDM skills
Individual
capacity
to
participate
in SDM
(n=44 studies)
Patient identified barriers & facilitators to
Shared Decision Making

4. SDM can be
learned (63 studies)
Healthcare professional
education combined with
audit & feedback
and/or
Patient-mediated
interventions such as
patient decision aids
(Légaré et al. 2014; 2017 update pending)

5. Inform
• Provide facts
Condition, options, benefits, harms
• Communicate probabilities
Clarify values
• Ask which benefits/harms matters most
• Share patient experiences
Support
• Guide in steps in deliberation/communication
• Worksheets, list of questions
Patient Decision Aids adjuncts to counseling
(Stacey et al., Cochrane Library, 2017)

6. Formats for patient decision aids
(used prior to or within consultations)
1. Print
2. DVD/Video
3. Online/computer-
based

7. 7
Compared to controls, PtDAs (105 RCTs)
Improve decision quality with…
 13% higher knowledge****
 110% more accurate risk
perception***
 106% better match between
values & choices **
 Reduce decisional conflict
(-9% uninformed; -9% unclear
values)****
 Help undecided to decide (36%)
 Support patients to be less passive
in decisions (32%) ***
 Improve patient-practitioner
communication (9/10; 1 no diff)
 Potential to reduce over-/under-use
 -16% elective surgery
 -12% PSA – prostate screening
 +65% new diabetes medicine
GRADE quality:
**** high ** low
*** moderate * very low
(Stacey et al., Cochrane Library, 2017;
Stacey et al., JAMA, 2017)

8. Timing of use
Of 105 trials of patient decision aids:
• 89 were used in preparation for consultations
• 16 were used within consultations
Findings revealed no difference between those
used in preparation or during consultations on:
– knowledge
– accurate risk perception
– patient-clinician communication
(Stacey et al., Cochrane Library, 2017)

9. 19 studies* showed:
- significantly better outcomes for disadvantaged patients
- maybe more beneficial to disadvantaged patients than for those with higher
literacy/ socioeconomic status
(*small sample sizes and various study quality)

10. Decision Aid Quality Concerns
• Patient decision aids can affect uptake of options
• Effect on uptake of options is desirable when
patient decision aids are
– unbiased
– change addresses unwarranted variations (e.g. poor
understanding, choices not based on patient preferences)
• Concern if uptake of options is due to biased
information
Elwyn et al., 2005; NQF report 2016; Stacey et al., 2014

11. International Patient
Decision Aid Standards
(IPDAS) Collaboration since 2003
IPDAS Steering Committee: Dawn Stacey & Robert Volk (co-leads),
M Barry, N Col, A Coulter, M Härter,
V Montori, N Moumjid, M Pignone,
R Thomson, L Trevena, T van der Weijden
To enhance the quality and effectiveness of patient decision
aids by establishing a shared evidence-informed framework
for improving their content, development, implementation,
and evaluation.
BMC Medical Informatics and Decision Making 2013, 13 (Suppl 2).
http://www.biomedcentral.com/bmcmedinformdecismak/supplements/13/S2

12. To find PtDAs on international inventory
Google: ‘decision aid’

14. 14

16. http://decisionaid.ohri.ca