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

BMC Medical Informatics and Decision Making

Review

Chirk Jenn Ng¹  Karen R Sepucha²  Carrie A Levin³  Joanne Lally⁴  Richard Thomson⁴  Natalie Joseph-Williams⁵  Celia E Wills⁶  Dawn Stacey⁷  Daniel D Matlock⁸  Mary E Ropka⁹  Cornelia M Borkhoff^1,10 

[1] Department of Primary Care Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia;Harvard Medical School and General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, 02114, Boston, Massachusetts, USA;Informed Medical Decisions Foundation, 40 Court Street, 02108, Boston, Massachusetts, USA;Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, NE2 4AX, Newcastle upon Tyne, UK;Institute of Primary Care and Public Health, Cardiff University, 2nd Floor, Neuadd Meirionnydd, CF14 4YS, HeathPark, Cardiff, UK;Ohio State University, 384 Newton Hall, 1585 Neil Avenue, 43210, Columbus, Ohio, USA;Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road., K1H 8L6, Ottawa, Ontario, Canada;School of Medicine, University of Colorado, 12631 E 17th Avenue, 80045, Aurora, Colorado, USA;School of Medicine, University of Virginia, P.O. Box 800717, 22908-0717, Charlottesville, Virginia, USA;Women’s College Research Institute, Women's College Hospital, 790 Bay Street, Room 728, M5G 1N8, Toronto, Ontario, Canada;

关键词: Measurement Instrument;    Realistic Expectation;    Decision Quality;    Hindsight Bias;    Decisional Conflict Scale;   

DOI  :  10.1186/1472-6947-13-S2-S12

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Sepucha et al; licensee BioMed Central Ltd. 2013