• Patient Decision Aids for shared decision making - Definition
• Purpose
• Evidence of Effectiveness
• Common Formats
• Guidelines to develop patient decision aids
• Evaluation measures

According fo the Cochrane Collaboration Systematic Review on Patient Decision Aids, these are tools:

• Designed as adjuncts to counceling
• For specific deliberate treatment/ screening choices
• They describe alternatives, benefits, and risks and potential outcomes tailored to the patients’ health status
• Are usually disease specific

Decision aids can also include:

• Information about the condition or disease
• Probabilities tailored to individual characteristics of the patient
• A value clarification exercise
• Guidance in the steps of decision making and communication

• To help patients participate in decisions about their health care
• To help providers in making treatment/ illness management decisions consistent with clinical evidence and patient preferences

Decision Aids can help patients (and clinicians) to:

• Consider and comprehend relevant clinical information
• Clarify and communicate personal values and preferences to clinicians.
• Engage with their clinicians in arriving at a decision/ plan of care that is consistent with these personal values and preferences.

Situations where DSS are appropriate

• Clinical evidence re. effectiveness of screening / testing / treatment indicates that there is no one “best” action
• The decision involves tradeoffs between benefits and harms
• Outcomes are uncertain, much is at stake
• The decision is associated with a wide range of strong personal values

• Help those uncertain at baseline
• Increase participation in decision making without increasing anxiety
• Improve knowledge, more realistic expectations, clearer personal preferences
• Reduce some aspects of decisional conflict
• Have an uncertain impact on adherence to treatment plans
• Have an uncertain impact on quality of life
• Have little impact on patient satisfaction

See also Reviews (O’Connor,et al. 2000, Molenaar, et al. 2001 in Bibliography)

Decision Support Systems for shared decision decison making come in different formats, such as:

• Paper & Pencil
• Video-discs
• Web-based
• Decision boards
• Audiotapes-workbooks
• Interactive PC-based

Decision Support Framework

1. are stimulated by a new circumstance, diagnosis, or developmental transition;
2. require careful deliberation because of the uncertain and/or value-sensitive nature of the benefits and risks; and
3. need relatively more effort during the deliberation phase than the implementation phase

The Ottawa decision support framework can be found here.

Guidelines for developing quality patient decision aids can be found on the Ottawa Decision Research Center website.

The Ottawa Guide for Decision Assessment and Planning is an interview guide for use by practitioners in assessing a patient’s decision support needs and developing a plan to meet those needs. It is based on the “Ottawa Decision Support Framework”.

Decision making is a complex, multifaceted process. Dr. O'Connor and colleagues have developed a number of outcome measures to capture aspects of decision making. Choice predisposition, expectations, decisional conflict and knowledge are important factorsare affected by decision aids. Tools are available on this Evaluation measures web site. These tools are copyrighted but free of charge. To obtain permission to use the tools, please e-mail Dr. Annette O’Connor (aoconnor@ohri.ca).

Computer-based systems contain:

• Evidence component, that consists of knowledge base containing the salient aspects of health/decision problem and available intervention options
• Assessment component, to obtain patient preferences
• Algorithms to arrive at and display the preferred choice