Dawn Stacey|France Légaré|Krystina B. Lewis|Michael J. Barry|Carol Bennett|Karen Eden|Margaret Holmes?Rovner|Hilary A. Llewellyn?Thomas|Anne Lyddiatt|Richard Thomson|Lyndal Trevena
Decision aids for people facing health treatment or screening decisions
University of Ottawa|Ottawa Hospital|The Quebec Population Health Research Network|Université Laval|University of Ottawa|Health Decisions (United States)|Ottawa Hospital|Oregon Health & Science University|Michigan State University|Dartmouth College|Newcastle University|University of Sydney
decision aids interventions support patients making decisions explicit providing information options associated benefitsharms helping clarify congruence decisions personal valuesto assess effects decision aids people facing treatment screening decisionsupdated search 2012 april 2015 central medline embase psycinfo grey literature includes cinahl september 2008we included published randomized controlled trials comparing decision aids usual care andor alternative interventions update excluded studies comparing detailed versus simple decision aidstwo reviewers independently screened citations inclusion extracted data assessed risk bias primary outcomes based international patient decision aid standards ipdas attributes related choice made decisionmaking processsecondary outcomes behavioural health health system effectswe pooled results using mean differences mds risk ratios rrs applying randomeffects model conducted subgroup analysis studies used patient decision aid prepare consultation used consultation used grade assess strength evidencewe included 105 studies involving 31043 participants update added 18 studies removed 28 previously included studies comparing detailed versus simple decision aids risk bias assessment rated two items selective reporting blinding participantspersonnel mostly unclear due inadequate reporting twelve 105 studies high risk biaswith regard attributes choice made decision aids increased participants knowledge md 1327100 95 confidence interval ci 1132 1523 52 studies n 13316 highquality evidence accuracy risk perceptions rr 210 95 ci 166 266 17 studies n 5096 moderatequality evidence congruency informed values care choices rr 206 95 ci 146 291 10 studies n 4626 lowquality evidence compared usual careregarding attributes related decisionmaking process compared usual care decision aids decreased decisional conflict related feeling uninformed md 928100 95 ci 1220 636 27 studies n 5707 highquality evidence indecision personal values md 881100 95 ci 1199 563 23 studies n 5068 highquality evidence proportion people passive decision making rr 068 95 ci 055 083 16 studies n 3180 moderatequality evidencedecision aids reduced proportion undecided participants appeared positive effect patientclinician communication moreover exposed decision aid either equally satisfied decision decisionmaking process andor preparation decision making compared usual caredecision aids also reduced number people choosing major elective invasive surgery favour conservative options rr 086 95 ci 075 100 18 studies n 3844 reduction reached statistical significance removing study prophylactic mastectomy breast cancer gene carriers rr 084 95 ci 073 097 17 studies n 3108 compared usual care decision aids reduced number people choosing prostatespecific antigen screening rr 088 95 ci 080 098 10 studies n 3996 increased choosing start new medications diabetes rr 165 95 ci 106 256 4 studies n 447 testing screening choices mostly differences decision aids usual carethe median effect decision aids length consultation 26 minutes longer 24 versus 21 75 increase costs decision aid group lower two studies similar usual care four studies people receiving decision aids appear differ receiving usual care terms anxiety general health outcomes conditionspecific health outcomes studies report adverse events associated use decision aidsin subgroup analysis compared results decision aids used preparation consultation versus consultation finding similar improvements pooled analysis knowledge accurate risk perception outcomes could conduct formal subgroup analyses studies subgroupcompared usual care across wide variety decision contexts people exposed decision aids feel knowledgeable better informed clearer values probably active role decision making accurate risk perceptions growing evidence decision aids may improve valuescongruent choices adverse effects health outcomes satisfaction new updated evidence indicating improved knowledge accurate risk perceptions decision aids used either within preparation consultation research needed effects adherence chosen option costeffectiveness use lower literacy populations