Decision aids for patients have recently been introduced in health care. A literature review was conducted to address the following research questions: 1) which types of decision aids have been developed?; 2) to what extent are they feasible, and acceptable to patients and health care providers?; 3) do decision aids affect the decision-making process and patients' outcomes? Thirty non-controlled (e.g., one-group-only designs) and controlled studies (e.g., randomized experimental designs) were identified. Decision aids were found to be feasible and acceptable to patients and to increase the agreement between patients' values and decisions and patients' knowledge. The effects of decision aids on decisions and on patients' outcomes, including decision uncertainty, satisfaction, and health, have rarely been addressed. When studied, the beneficial effects of decision aids on these outcomes appear to be rather modest. Implications for future development of decision aids and the design of studies are discussed. Key words: shared decision making; patient decision aids. (Med Decis Making 2000;20:112-127)
Get full access to this article
View all access options for this article.
References
1.
Szasz TS, Hollender MH.A contribution to the philosophy of medicine. The basic models of the doctor-patient relationship. Arch Intern Med1956;97:585-92.
2.
Emanuel EJ, Emanuel LL.Four models of the doctor-patient relationship . JAMA.1996,267.2221-6.
3.
Laine C, Davidoff F.Patient centered medicine. A professional evolution . JAMA1996,275:152-6
4.
Kasper JF, Mulley AG, Wennberg JE.Developing shared decision-making programs to improve the quality of health careQuality Rev Bull1992;18:183-90.
5.
Llewellyn-Thomas HA.Patients' health-care decision making: a framework for descriptive and experimental investigations. Med Decis Making.1995;15:101-6.
6.
Quill TE, Brody H.Physician recommendations and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med.1996;125:763-9.
7.
Charles C, Gafni A, Whelan T.Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango. Soc Sci Med.1997 ;44:681-92.
8.
Beisecker A, Beisecker TD.Patient information-seeking behaviors when communicating with doctors. Med Care1990; 28:19-28.
9.
Roter DL, Hall JA.Doctors Talking With Patients, Patients Talking With DoctorsWestport, CT: Auburn House, 1992.
10.
Manfredi C, Czaja R, Buis M, Derk D.Patient use of treatment-related information received from the cancer information service. Cancer.1993;71:1326-37.
11.
Bilodeau BA, Degner LF.Information needs, sources of information, and decisional roles in women with breast cancer. Oncol Nurs Forum.1996,23:691-6.
12.
Hack TF, Degner LF, Dyck DG.Relationship between preferences for decisional control and illness information among women with breast cancer: a quantitative and qualitative analysisSoc Sci Med.1994;39:279-89.
13.
Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB.Information and decision making preferences of hospitalized adult cancer patients. Soc Sci Med.1988,27:1139-45
14.
Cassileth BR, Zupkis RV, Sutton-Smith K, March V.Information and participation preferences among cancer patients. Ann Intern Med.1980;92:832-6.
15.
Deber RB, Kraetschmer N, Irvine J.What role do patients wish to play in treatment decision making?Arch Intern Med1996;156:1414-20.
16.
Greenfield S, Kaplan S, Ware JE.Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med.1985;102:520-8.
17.
Greenfield S, Kaplan S, Ware JE, Martin Yano E, Frank HJLPatients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med.1988;3:448-57.
18.
Kaplan SH, Greenfield S, Ware JE.Assessing the effects of physician-patient interactions on the outcomes of chronic diseaseMed Care. 1989;27:S110.
19.
Street RL, Voigt B, Geyer C, Manning T, Swanson GP.Increasing patient involvement in choosing treatment for early breast cancerCancer. 1995;76:2275-85.
20.
Haynes RB, McKibbon KA, Kanani R.Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications . Lancet.1996;348:383-86.
21.
Ong LML, de Haes JCJM,Hoos AM, Lammes FB.Doctor-patient communication: a review of the literature. Soc Sci Med.1995 ;40:903-18.
22.
Stewart MA, Roter DLIntroduction. In: Stewart MA, Roter DL (eds). Communicating With Medical PatientsNewbury Park, CA: Sage Publications, 1989.
23.
Sutherland H, Llewellyn-Thomas HA, Lockwood GA, Tritchler DL, Till JE.Cancer patients: their desire for information and participation in treatment decisionsJ R Soc Med.1989; 82:260-3.
24.
Strull W, Lo B, Charles GDo patients want to participate in medical decision making?JAMA1984;252:2990-4.
25.
Ende J, Kazis L, Ash A, Moskowitz MAMeasuring patients' desire for autonomyJ Gen Intern Med.1989,4.23-30
26.
Degner LF, Kristjanson LJ, Bowman D, et al Information needs and decisional preferences in women with breast cancerJAMA1997;277.1485-92.
27.
DiMatteo RM.The physician-patient relationship effects on the quality of health careClin Obstet Gynecol1994;37:149-61
28.
O'Connor AM.Validation of a decisional conflict scale. Med Decis Making.1995;15:25-30
29.
O'Connor AM, Llewellyn-Thomas H, Drake E.Annotated Bibliography of Research on Shared Decision Making. Toronto, ON, Canada. National Cancer Institute of Canada, 1995
Maisels MJ, Hayes B, Conrad S, Chez RA.The effect of information on parental decision makingPediatrics1983;71:453-5
32.
Owens RG, Ashcroft JJ, Leinster SJ, Slade PD.Informal decision analysis with breast cancer patients: an aid to psychological preparation for surgeryJ Psychosoc Oncol. 1987,5. 23-33
33.
Fetting JH, Siminoff LA, Piantadosi S, Abeloff MD, Damron DJ, Sarsfield AMEffect of patients' expectations of benefit with standard breast cancer adjuvant chemotherapy on participation in randomized clinical trial a clinical vignette studyJ Clin Oncol1990;8:1476-82
34.
Levine MN, Gafni A, Markham B, MacFarlane D.A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer. Ann Intern Med.1992;117.53-58.
35.
Neufeld KR, Degner LF, Dick AM.A nursing intervention strategy to foster patient involvement in treatment decisions. Oncol Nurs Forum.1993;20:631-5.
36.
Deber R, Kraetschmer N, Trachtenberg JShared decision making how does one measure success (abstrMed Decis Making1994,14:429.
37.
Barry MJ, Fowler FJ, Mulley AG, et al Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia. Med Care.1995;33771-82.
38.
Chapman GB, Elstein AS, Hughes KK.Effects of patient education on decisions about breast cancer treatments. a preliminary reportMed Decis Making1995 ;15.231-9.
39.
Holmes-Rovner M, Rovner D, Kroll J, Rothert M, Padonu G, Talarczyk G.Does decision support make people more rational (abstr? Med Decis Making.1995;15:418.
40.
Llewellyn-Thomas HA, Thiel EC, Sem WC, Harrison Woermke DE.Presenting clinical trial information: a comparison of methodsPat Educ Couns1995;25:97-107
41.
Sebban C, Browman G, Gafni A, et al. Design and validation of a bedside decision instrument to elicit a patient's preference concerning allogenic bone marrow transplantation in chronic myeloid leukemiaAm J Hematol. 1995 ;48:221-7.
42.
Van Ruiswijk J, Griffin R, Schapira M.Informing patients about prostate cancer screening risks (abstr. Med Decis Making.1995;15:421.
43.
Wagner EH, Barrett P, Barry MJ, Barlow W, Fowler FJThe effect of a shared decision making program on rates of surgery for benign prostatic hyperplasiaMed Care. 1995;33: 765-70
44.
Whelan TJ, Levine MN, Gafni A, et al Breast irradiation post-lumpectomy : development and evaluation of a decision instrument. J Clin Oncol1995,13.847-53
45.
Elit LM, Levine MN, Gafni A, et al Patients' preferences for therapy in advanced epithelial ovarian cancer development, testing, and application of a bedside decision instrument. Gynaecol Oncol1996;62.329-35
46.
Flood AB, Wennberg JE, Nease RF, Fowler FJ, Ding J, Hynes LMThe importance of patient preferences in the decision to screen for prostate cancerJ Gen Intern Med. 1996,11: 342-9.
47.
Liao L, Jollis JG, DeLong ER, Peterson ED, Morris KG, Mark DB.Impact of an interactive video on decision making of patients with ischemic heart disease. J Gen Intern Med.1996; 11.373-6.
48.
Molenaar S, Sprangers MAG, de Haes JCJMAn interactive computer program on breast cancer: reactions of patients and surgeons (abstr. Psy-oncol.1998;7:175
49.
O'Connor AM, Pennie RA, Dales RE.Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol.1996;49:1271-6.
50.
Wolf AMD, Nasser FJ, Wolf AM, Schorling JB.The impact of informed consent on patient interest in prostatic-specific antigen screeningArch Intern Med. 1996;156:1333-6.
51.
Barry MJ, Cherkin DC, Chang Y, Fowler FJ, Skates S.A randomized trial of a multimedia shared decision-making program for men facing a treatment decision for benign prostatic hyperplasiaDis Manage Clin Outcomes. 1997;1.5-14
52.
Lerman C, Biesecker B, Benkendorf JL, et al. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst1997; 89:148-57
53.
Rothert ML, Holmes-Rovner M, Rovner D, et al An educational intervention as decision support for menopausal womenRes Nurs Health. 1997;20:377-87
54.
Schapira MM, Meade C, Nattinger AB.Enhanced decision-making: the use of a videotape decision-aid for patients with prostate cancer. Pat Educ Couns.1997 ;30:119-27.
55.
Bernstein SJ, Skarupski KA, Grayson CE, Starling MR, Bates ER, Eagle KA.A randomized controlled trial of information-giving to patients referred for coronary angiography: effects on outcomes of care. Health Expectations1998;1:50-61
56.
O'Connor AM, Tugwell P, Wells GA, et al. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluationPat Educ Couns. 1998;33.267-79.
57.
O'Connor AM, Tugwell P, Wells GA, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapyMed Decis Making. 1998;18:295-303.
58.
Sawka CA, Goel V, Mahut CA, et al. Development of patient decision aid for choice of surgical treatment for breast cancer. Health Expectations.1998;1:23-36
59.
Stalmeier PFM, Unic IJ, Verhoef LCG, van Daal WAJ.Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer. Med Decis Making.1999,19:230-41.
60.
O'Connor AM, Llewellyn-Thomas HA, Sawka C, Pinfold SP, To , T,Harrison DEPhysicians' opinions about decision aids for patients considering systematic adjuvant therapy for axillary-node negative breast cancer. Pat Educ Couns.1997;30: 143-53.
61.
O'Connor AM.Validation of a decisional conflict scale. Med Decis Making.1995;15:25-30.
62.
Holmes-Rovner M, Rovner D, Kroll J, Rothert M, Padonu G, Talarczyk GPatient satisfaction with health care decisions the satisfaction with decision scale. Med Decis Making1996; 16:58-64
63.
Hollen PJ.Psychometric properties of two instruments to measure quality decision making. Res Nurs Health.1994;17137-48
