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Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis

Ottawa Health Research Institute, Canada, University of Ottawa, Canada, ohdec{at}ohri.ca

Dawn Stacey, RN, PhD

University of Ottawa, Canada

Michael J. Barry, MD

Massachusetts General Hospital, Boston

Nananda F. Col, MD, MPH, MPP

Maine Medical Center, Portland, Maine

Karen B. Eden, PhD

Oregon Health and Science University, Portland

Vikki Entwistle, PhD

Social Dimensions of Health Institute, Dundee, UK

Valerie Fiset, MScN

Algonquin College, Ottawa, Canada

Margaret Holmes-Rovner, PhD

Michigan State University, East Lansing

Sara Khangura

Ottawa Health Research Institute, Canada

Hilary Llewellyn-Thomas, PhD

Dartmouth Medical School, Hanover, New Hampshire

David R. Rovner, MD

Michigan State University, East Lansing

Objective. To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS). Data sources. Five electronic databases (to July 2006) and personal contacts (to December 2006). Results. Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = —8.4, 95% CI = —11.9 to —4.8; unclear values WMD = —6.3, 95% CI = —10.0 to —2.7). There was no difference in process measures when detailed and simple PtDAs were compared. Conclusions. PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.

Key Words: Key words: decision support techniques • patient education • patient participation • randomized controlled trials. (Med Decis Making 2007;27:554—574)

This version was published on October 1, 2007

Medical Decision Making, Vol. 27, No. 5, 554-574 (2007)
DOI: 10.1177/0272989X07307319


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