Ayudas a la toma de decisiones para pacientes que deben decidir sobre tratamientos o pruebas de detección
Información
- DOI:
- https://doi.org/10.1002/14651858.CD001431.pub5Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 12 abril 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Consumidores y comunicación
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Citado por:
Autores
Contributions of authors
1999 Review (O'Connor 1999b):
AO, AR, VF, JT, VE, HLT, MHR, VF, MB, and JJ contributed to the design of the protocol, the interpretation of results, and the revision and approved the final paper.
AO led the team, and JT coordinated the project.
AO, MH‐R, AR, VF, and JT pilot tested the data extraction forms.
AR, VF, and JT screened studies and extracted data.
AR, JT, and AO analyzed the results.
2001 Review (O'Connor 2001):
AO, DS, DR, MHR, HLT, VE, MB, JT, VF, and AR contributed to the interpretation of results and the revision and approved the final paper.
AO led the team, and DS coordinated the update.
AO, DR, MHR, HLT, JT, DS, and JP screened studies and extracted data.
DS and JP evaluated decision aids using the CREDIBLE criteria.
AO and DS analyzed the results.
2002 Review (O'Connor 2003):
AO, DS, DR, MHR, HLT, VE, MB, JT, and VF contributed to the interpretation of results and the revision and approved the final paper.
AO led the team, and DS coordinated the update.
DS, JP, VT, and JT screened studies and extracted data.
DS, JP, VT, and SK evaluated decision aids using the CREDIBLE criteria.
AO and DS analyzed the results.
2006 Review (O'Connor 2009b):
AO, CB, DS, MB, NC, KE, VE, VF, MHR, SK, HLT, DR, contributed to the interpretation of results, and the revision and final approval of the paper.
AO led the team and CB coordinated the update.
CB, SK, DS, AO, VF screened studies and extracted data.
AO and CB analyzed the results.
2009 Review (Stacey 2011):
DS, CB, MB, NC, KE, FL, AL, MHR, HLT, and RT contributed to the interpretation of results, and the revision and approved the final paper.
DS led the team, and CB coordinated the update.
CB and DS screened studies; SM and AD extracted data; CB entered the data; DS verified the data entered.
DS and CB analyzed the results.
2013 Review (Stacey 2014b):
DS, CB, MB, NC, KE, FL, AL, MHR, HLT, RT, and LT contributed to the interpretation of results and the revision and approved the final paper.
DS led the team with help coordinating the update from SB and JW.
CB, DS, RT, MB, MHR, NC, KE, BV, DR, and AS screened studies; SB, RW, JW, and CC extracted data; SB and JW entered the data; DS verified the data entered.
DS and JW analyzed the results.
2016 (current) Review:
DS, CB, MB, KE, FL, AL, MHR, HLT, RT, LT, and KL contributed to the interpretation of results and the revision and approved the final paper.
DS led the team with help coordinating the update from KL.
CB, DS, RT, MB, MHR, KE, DR, and AS screened studies; KL and IS extracted data; KL entered the data; DS verified the data entered.
DS analyzed the results.
Sources of support
Internal sources
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University of Ottawa, Canada.
University Research Chair in Knowledge Translation to Patients
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Ottawa Hospital Research Institute, Canada.
Scientific Director, Patient Decision Aids Research Group
External sources
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No sources of support supplied
Declarations of interest
Several of the investigators have developed patient decision aids (DS, FL, HL, MHR, MB, KE, RT, LT, KL), but none reviewed their own studies.
Within the last five years, two investigators (HL, MB) have received financial support from the not‐for‐profit Informed Medical Decisions Foundation (IMDF). MB serves on the Board of and received salary and grant support as President of the Foundation. In 2014, the Foundation merged with another not‐for‐profit, Healthwise. MB continues to receive salary and grant support as Chief Science Officer at Healthwise. Healthwise develops, licenses, and distributes patient decision aids. Several investigators (DS, FL, HL, MHR, MB, KE, RT, LT) who were involved in a special issue in BMC Medical Informatics and Decision Making that included a series of 14 papers focused on the theoretical and empirical evidence underlying the International Patient Decision Aid Standards (IPDAS), received partial funding from the Foundation to cover publishing costs.
Acknowledgements
The Cochrane Consumers and Communication Group (editors, academic and consumer referees) provided peer review and advice regarding the review and checked extracted data for newly included studies. We thank John Kis‐Rigo at La Trobe University who revised the search strategy used since the 2014 update. David Rovner and Nananda Col helped with screening studies for inclusion, and Intissar Souli assisted with data extraction and 'Risk of bias' assessment. Anton Saarimaki set up and managed a web‐based title and abstract screening application that facilitated independent screening of citations by the review authors, and he also verified references for patient decision aids in Table 1. Alain Mayhew provided guidance in the interpretation of the 'Summary of findings' table. Dean Fergusson provided consultation on the statistical analysis.
Version history
| Published | Title | Stage | Authors | Version |
| 2024 Jan 29 | Decision aids for people facing health treatment or screening decisions | Review | Dawn Stacey, Krystina B Lewis, Maureen Smith, Meg Carley, Robert Volk, Elisa E Douglas, Lissa Pacheco-Brousseau, Jeanette Finderup, Janet Gunderson, Michael J Barry, Carol L Bennett, Paulina Bravo, Karina Steffensen, Amédé Gogovor, Ian D Graham, Shannon E Kelly, France Légaré, Henning Sondergaard, Richard Thomson, Logan Trenaman, Lyndal Trevena | |
| 2017 Apr 12 | Decision aids for people facing health treatment or screening decisions | Review | Dawn Stacey, France Légaré, Krystina Lewis, Michael J Barry, Carol L Bennett, Karen B Eden, Margaret Holmes‐Rovner, Hilary Llewellyn‐Thomas, Anne Lyddiatt, Richard Thomson, Lyndal Trevena | |
| 2014 Jan 28 | Decision aids for people facing health treatment or screening decisions | Review | Dawn Stacey, France Légaré, Nananda F Col, Carol L Bennett, Michael J Barry, Karen B Eden, Margaret Holmes‐Rovner, Hilary Llewellyn‐Thomas, Anne Lyddiatt, Richard Thomson, Lyndal Trevena, Julie HC Wu | |
| 2011 Oct 05 | Decision aids for people facing health treatment or screening decisions | Review | Dawn Stacey, Carol L Bennett, Michael J Barry, Nananda F Col, Karen B Eden, Margaret Holmes‐Rovner, Hilary Llewellyn‐Thomas, Anne Lyddiatt, France Légaré, Richard Thomson | |
| 2009 Jul 08 | Decision aids for people facing health treatment or screening decisions | Review | Annette M. O'Connor, Carol L Bennett, Dawn Stacey, Michael Barry, Nananda F Col, Karen B Eden, Vikki A Entwistle, Valerie Fiset, Margaret Holmes‐Rovner, Sara Khangura, Hilary Llewellyn‐Thomas, David Rovner | |
| 2003 Jan 20 | Decision aids for people facing health treatment or screening decisions | Review | Annette M. O'Connor, Carol L Bennett, Dawn Stacey, Michael Barry, Nananda F Col, Karen B Eden, Vikki A Entwistle, Valerie Fiset, Margaret Holmes‐Rovner, Sara Khangura, Hilary Llewellyn‐Thomas, David Rovner | |
Differences between protocol and review
There are three main differences between the original protocol and the review. We re‐structured the 2009 update, O'Connor 2009b, to organize the long list of outcomes into primary and secondary outcomes based on the new effectiveness criteria of the International Patient Decision Aid (IPDAS) Collaboration (Elwyn 2006). For the 2011 update, Stacey 2011, we changed the study quality assessment to the 'Risk of bias' assessment (Higgins 2011). For the 2014 update, Stacey 2014b, we used GRADE to summarize the quality of the evidence and reported the results using summary of findings Table for the main comparison.
For the 2016 (current) update, we removed 28 studies that compared detailed versus simple decision aids. This update is limited to comparisons of patient decision aids versus usual care to provide a more focused review. This change resulted in removal of these comparisons for pooled results including knowledge scores, decisional conflict, perceived participation in decision making, proportion undecided, choice, and satisfaction. For other outcomes including congruence between chosen option‐values and accurate risk perception, the new pooled comparisons only focus on patient decision aid versus usual care, rather than previous comparisons that reported on patient decision aids with explicit values clarification and probabilities of outcomes versus any comparisons without these features.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans;
PICO
Study flow diagram.
Risk of bias summary as percentages across all included studies.
Risk of bias summary for each included study.
Funnel plot of comparison: 1 Knowledge, outcome: 1.1 Knowledge ‐ all studies.
Funnel plot of comparison: 4.1 Decisional conflict: DA vs usual care ‐ all studies, outcome: 4.1.2 Uninformed subscale
Funnel plot of comparison: 4.1 Decisional conflict: DA vs usual care ‐ all studies, outcome: 4.1.3 Unclear subscale
Comparison 1 Knowledge, Outcome 1 Knowledge ‐ all studies.
Comparison 1 Knowledge, Outcome 2 Knowledge ‐ subgroup by timing of intervention (in consultation versus in preparation for consultation).
Comparison 1 Knowledge, Outcome 3 Knowledge ‐ studies without high risk of bias.
Comparison 2 Accurate risk perceptions, Outcome 1 Accurate risk perceptions ‐ all studies.
Comparison 2 Accurate risk perceptions, Outcome 2 Accurate risk perceptions ‐ subgroup by timing of intervention (in consultation versus in preparation for consultation).
Comparison 2 Accurate risk perceptions, Outcome 3 Accurate risk perceptions ‐ studies without high risk of bias.
Comparison 3 Informed values‐choice congruence, Outcome 1 Informed values‐choice congruence ‐ all studies.
Comparison 3 Informed values‐choice congruence, Outcome 2 Informed values‐choice congruence ‐ actual choice only.
Comparison 3 Informed values‐choice congruence, Outcome 3 Informed values‐chose congruence ‐using MMIC.
Comparison 3 Informed values‐choice congruence, Outcome 4 Informed values‐chose congruence ‐ heterogeneous measures.
Comparison 3 Informed values‐choice congruence, Outcome 5 Informed values‐choice congruence ‐ without studies of high risk of bias.
Comparison 4 Decisional conflict, Outcome 1 Decisional conflict ‐ all studies.
Comparison 4 Decisional conflict, Outcome 2 Decisional conflict ‐ in consultation.
Comparison 4 Decisional conflict, Outcome 3 Decisional conflict ‐ in preparation for consultation.
Comparison 4 Decisional conflict, Outcome 4 Decisional conflict ‐ without studies having high risk of bias.
Comparison 5 Participation in decision making, Outcome 1 Participation in decision making ‐ all studies.
Comparison 5 Participation in decision making, Outcome 2 Participation in decision making ‐ in consultation.
Comparison 5 Participation in decision making, Outcome 3 Participation in decision making ‐ in preparation for consultation.
Comparison 6 Proportion undecided, Outcome 1 Proportion undecided ‐ all studies.
Comparison 7 Satisfaction, Outcome 1 Satisfaction with the choice ‐ all studies.
Comparison 7 Satisfaction, Outcome 2 Satisfaction with the choice ‐ in consultation.
Comparison 7 Satisfaction, Outcome 3 Satisfaction with the choice ‐ in preparation for consultation.
Comparison 7 Satisfaction, Outcome 4 Satisfaction with the decision making process ‐ all studies.
Comparison 7 Satisfaction, Outcome 5 Satisfaction with the decision making process ‐ in consultation.
Comparison 7 Satisfaction, Outcome 6 Satisfaction with the decision making process ‐ in preparation for consultation.
Comparison 8 Choice, Outcome 1 Choice: surgery over conservative option.
Comparison 8 Choice, Outcome 2 Choice for screening.
Comparison 8 Choice, Outcome 3 Choice: diabetes medication (uptake new medication).
| Patient decision aids compared with usual care for adults considering treatment or screening decisions | ||||||
| Patient or population: adults considering treatment or screening decisions Settings: all settings Intervention: patient decision aid Comparison: usual care | ||||||
| Outcomes | Illustrative comparative benefits* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Assumed benefit | Corresponding benefit | |||||
| Usual care | Patient decision aid | |||||
| Knowledge ‐ all studies Standardized on score from 0 (no knowledge) to 100 (perfect knowledge), soon after exposure to the decision aid | The mean knowledge score was 56.9% across control groups, ranging from 27.0% to 85.2% | The mean knowledge score in the intervention groups was 13.27 higher (11.32 to 15.23 higher) | — | 13,316 | ⊕⊕⊕⊕ | Higher scores indicate better knowledge. 46 out of 52 studies showed a statistically significant improvement in knowledge |
| Accurate risk perceptions ‐ all studies Assessed soon after exposure to the decision aid | 269 per 1000c | 565 per 1000 (447 to 716 per 1000) | RR 2.10 (1.66 to 2.66) | 5096 | ⊕⊕⊕⊝ | — |
| Congruence between the chosen option and informed values ‐ all studies Assessed soon after exposure to the decision aid | 289 per 1000c | 595 per 1000 (422 to 841 per 1000) | RR 2.06 (1.46 to 2.91) | 4626 (10 studies) | ⊕⊕⊝⊝ | — |
| Decisional conflict: uninformed subscale ‐ all studies Standardized on score from 0 (not uninformed) to 100 (uninformed) Assessed soon after exposure to the decision aid | The mean for outcome 'feeling uninformed' ranged across control groups from 11.1 to 61.1. Scores ≤ 25 associated with following through on decisions. Scores > 38 associated with delay in decision making | The mean feeling uninformed in the intervention groups was 9.28 lower (12.20 to 6.36 lower) | — | 5707 (27 studies) | ⊕⊕⊕⊕ | Lower scores indicate feeling more informed |
| Decisional conflict: unclear about personal values subscale ‐ all studies Standardized on score from 0 (not unclear) to 100 (unclear) Assessed soon after exposure to the decision aid | The mean for outcome 'feeling unclear about personal values' ranged across control groups from 15.5 to 53.2. Scores ≤ 25 associated with follow‐through with decisions. Scores > 38 associated with delay in decision making | The mean feeling unclear values in the intervention groups was 8.81 lower (11.99 to 5.63 lower) | — | 5068 (23 studies) | ⊕⊕⊕⊕ | Lower scores indicate feeling clearer about values |
| Participation in decision making: clinician‐controlled decision making ‐ all studies Assessed soon after consultation with clinician | 228 per 1000c | 155 per 1000 (125 to 189 per 1000) | RR 0.68 (0.55 to 0.83) | 3180 | ⊕⊕⊕⊝ | Patient decision aids aim to increase patient involvement in making decisions; lower proportion of clinician‐controlled decision making is better |
| Adverse events | There were no adverse effects on health outcomes or satisfaction, and no other adverse effects reported. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aThe vast majority of studies measuring this outcome were not at high risk of bias. | ||||||
| Study | Topic | Availability | Source | Contact Information |
| Prostate cancer screening | No | Allen, Center for Community‐Based Research, Dana‐Farber Cancer Institute, Boston, MA, USA, 2010 | Requested access | |
| Bariatric surgery | Yes | Informed Medical Decisions Foundation, MA,USA, 2010 | informedmedicaldecisions.org/imdf_decision_aid/making‐decisions‐about‐weight‐loss‐surgery/ | |
| Prostate cancer treatment | Yes | Auvinen, Helsinki, Finland, 1993 | Included in publication | |
| Benign prostate disease treatment | Yes | Informed Medical Decisions Foundation, MA, USA, 2001 | informedmedicaldecisions.org/imdf_decision_aid/treatment‐options‐for‐benign‐prostatic‐hyperplasia/ | |
| Prenatal screening | Yes | Bekker, Leeds, UK, 2003 | Included in publication | |
| Ischaemic heart disease treatment | Yes | Informed Medical Decisions Foundation, MA,USA, 2002 | informedmedicaldecisions.org/imdf_decision_aid/treatment‐choices‐for‐carotid‐artery‐disease/ | |
| Prostate cancer treatment | No | Berry, Phyllis F. Cantor Center, MA, USA, 2011 | ||
| Antenatal Down syndrome screening | Yes | Södersjukhuset, Department of Obstetrics and Gynecology, Stockholm, Sweden | ||
| Osteoarthritis of the knee or hip | No | Informed Medical Decisions Foundation and Health Dialog; USA | ||
| Pelvic Organ Prolapse | Yes | Healthwise, USA | ||
| Prostate cancer treatment | No | C Chabrera. School of Health Sciences, Department of Nursing. Mataro, Spain | ||
| Healthcare personnel’s influenza immunization | Yes | A McCarthy. Ottawa Influenza Decision Aid Planning Group, CA, 2008 | ||
| Hepatitis B Vaccine | No | Clancy, Richmond VA, USA, 1983 | — | |
| Prostate cancer treatment | No | Davison, Manitoba CA, 1992‐1996 | — | |
| Total | Yes | Informed Medical Decisions Foundation, MA,USA | informedmedicaldecisions.org/imdf_decision_aid/treatment‐choices‐for‐knee‐osteoarthritis/ | |
| Colon cancer screening | No | Dolan, Rochester NY, USA, 1999 | — | |
| Prostate cancer screening | Yes | Elwyn, Cardiff, UK | ||
| Breast cancer prevention | Yes | Fagerlin, Ann Arbor, MI, USA | — | |
| Osteoarthritis knee treatment | No | Fraenkel, New Haven CT, USA | Author said DA never fully developed, all info in paper | |
| Atrial fibrillation | No | Veterans Affairs Connecticut Healthcare System, USA | Obtained from author | |
| Prostate cancer screening | No | Frosch, Los Angeles, USA | Screenshots from author | |
| Prostate cancer screening | Yes | Gatellari, Sydney, AU, 2003 | included in publication | |
| Prostate cancer screening | Yes | Gatellari, Sydney, AU, 2003 | Included in publication | |
| Breast cancer genetic testing | Yes | Green, Hershey PA, USA, 2000 | 1‐800‐757‐4868 [email protected] | |
| Schizophrenia treatment | Yes | Hamann, Munich, GER | Emailed by author (in German) | |
| Feeding options in advanced | Yes | Mitchell, Tetroe, O'Connor; 2001 (updated 2008) | ||
| Breast reconstruction | Yes | University of Texas MD Anderson Cancer Center, Houston TX, USA, 2003 | Disc mailed | |
| Stress testing for chest pain | Yes | Hess, Rochester, MN, USA, 2012 | Included in publication | |
| Breast cancer treatment | Yes | Jibaja‐Weiss, Baylor College of Medicine, 2010 | ||
| Endodontic treatment | Yes | Johnson, Chicago, USA, 2004 | Included in publication | |
| Multiple sclerosis | No | Jürgen Kasper | — | |
| Abnormal uterine bleeding treatment | No | Kennedy/Coulter, London UK, 1996 | — | |
| Asymptomatic Abdominal Aortic Aneurysm treatment | Yes | Amsterdam, The Netherlands | ||
| Prostate cancer screening | Yes | Krist, Fairfax VA, USA | ||
| Dental ‐ posterior tooth decay | Yes | University of Cologne, Cologne, Germany | jana.kupke@uk‐koeln.de | |
| Prenatal screening | No | Kuppermann, San Francisco CA, USA | Interactive web‐based decision aid | |
| Breast cancer treatment | Yes | Kwong Wah Hospital, Hong Kong, China | Obtained from author. | |
| Contraceptive method choice | Yes | World Health Organization, 2005 | www.who.int/reproductivehealth/publications/family_planning/9241593229index/en/index.html | |
| Pre‐operative autologous blood donation | No | Laupacis, Ottawa, CA, 2001 | ||
| Treatment for osteoporosis | Yes | Mayo Clinic | — | |
| Natural health products | No | Legare, Quebec City, CA, 2006 | — | |
| Use of antibiotics for acute | Yes | Legare, Quebec City, CA, 2007 | ||
| Antibiotics for acute respiratory infections | Yes | Legare, Quebec City, CA | ||
| Advanced colorectal cancer chemotherapy | Yes | Princess Margaret Hospital, Toronto, 2011 | ||
| Prostate cancer screening | Yes | Sally Weinrich University of Louisville, USA | Obtained from author | |
| Breast cancer genetic testing | No | Lerman/Schwartz, Washington DC, USA, 1997 | — | |
| Colorectal cancer | Yes | Lewis, University of North Carolina, Chapel Hill, NC, USA, 2010 | ||
| Depression treatment | Yes | Loh, Freiburg, GER | Emailed to us by author ‐ in German | |
| Atrial fibrillation treatment | No | McAlister/Laupacis, Ottawa CA, 2000 | ||
| Diabetes treatment ‐ statins | Yes | Montori, Rochester MN, USA | ||
| Diabetes | Yes | Marteau, King's College London, London, England, 2010 | Additional file 2 of publication | |
| Diabetes | Yes | Marteau, King's College London, London, England, 2010 | Provided by author, same DA as Mann E 2010 | |
| Mammography | Yes | Mathieu, Sydney, AU | DA emailed by author | |
| Diabetes treatment | Yes | The University of Sheffield, Sheffield, UK, 2008 | Obtained from author | |
| Mammography | Yes | Mathieu, University of Sydney, AUS, 2010 | ||
| Atrial fibrillation treatment | No | McAlister/Laupacis, Ottawa CAN, 2000 | ||
| Hormone replacement therapy | Yes, update in progress | Sigler/Bastien, Durham NC, USA, 1998 | ||
| Screening after mildly abnormal pap smear | Yes | Screening & test evaluation program, School of public health, University of Sydney 2007 | ||
| BRCA1/BRCA2 gene testing | No | Miller, Fox Chase PA, USA | — | |
| Colorectal | Yes | University of North Carolina, Chapel Hill, NC, USA, 2007 | intmedweb.wakehealth.edu/choice/choice.html (no longer available) | |
| Hypertension treatment | No | Montgomery, UK, 2000 | — | |
| Birthing options after caesarean | Yes | Montgomery, Bristol, UK, last update 2004 | www.computing.dundee.ac.uk/acstaff/cjones/diamond/Information.html | |
| Osteoporosis treatment | Yes | Montori, Mayo Foundation for Medical Education and Research, 2007 | shareddecisions.mayoclinic.org/decision‐aids‐for‐diabetes/other‐decision‐aids/ | |
| Ischaemic heart disease treatment | Yes | Informed Medical Decisions Foundation, MA, USA, 2002 | informedmedicaldecisions.org/imdf_decision_aid/treatment‐choices‐for‐carotid‐artery‐disease/ | |
| PTSD treatment | Yes | Michael E DeBakey Veterans Affairs Medical Center, Houston, USA | Obtained from author | |
| Diabetes treatment | Yes | Montori or Mayo Foundation(?) Rochester MN, USA, | Included in publication | |
| Benign prostate disease treatment | Yes | Informed Medical Decisions Foundation, MA, USA, 2001 | informedmedicaldecisions.org/imdf_decision_aid/treatment‐options‐for‐benign‐prostatic‐hyperplasia/ | |
| Hormone replacement therapy | No, update in progress | Informed Medical Decisions Foundation, MA, USA | informedmedicaldecisions.org/imdf_decision_aid/treatment‐choices‐for‐managing‐menopause/ | |
| Prenatal screening | Yes | Nagle, Victoria, AU | ||
| Birth breech presentation | Yes | Nassar, West Perth WA, AU | sydney.edu.au/medicine/public‐health/shdg/resources/decision_aids.php | |
| Osteoporosis treatment | No | Cranney, Ottawa CA, 2002 | ||
| Breast cancer prevention | No | Ozanne, Boston MA, USA | — | |
| Prostate cancer screening | Yes | Informed Medical Decisions Foundation, MA,USA, 2001 | informedmedicaldecisions.org/imdf_decision_aid/deciding‐if‐the‐psa‐test‐is‐right‐for‐you/ | |
| Colon cancer screening | Yes | Pignone, Chapel Hill NC, USA, 1999 | ||
| Menorrhagia treatment | No | Protheroe, Manchester, UK | Computerized decision aid, Clinical Guidance Tree ‐ no longer in existence, author sent chapter in thesis | |
| Prostate cancer screening | No | Centers for Disease Control and Prevention (CDC), USA, 2010 | No longer available | |
| Colorectal cancer screening | Yes | Regents of the University of Michigan (copyright info), Ann Arbor MI, USA, 2006 | ||
| Adjuvant radioactive iodine treatment for patients with early‐stage papillary thyroid cancer | No | University Health Network, Toronto, Canada, 2009 | — | |
| Colorectal | Yes | Schroy III, Boston, USA | ||
| Coronary angiogram access site | Yes | Schwalm, Hamilton, ON, Canada, 2009 | www.phri.ca/workfiles/studies/presentations/PtDA%20Vascular%20Access%2023‐May−2012.pdf | |
| Breast cancer genetic testing | No | Schwartz/Lerman, Washington DC, USA, 1997 | — | |
| BRCA mutation prophylactic surgery | No | Schwartz, Washington DC, USA | — | |
| Cardiovascular prevention | Yes | Sheridan, Chapel Hill, NC, USA | ||
| Coronary heart | Yes | Sheridan, University of North Carolina at Chapel Hill, Division of General Internal Medicine, North Carolina, USA, 2011 | ||
| Birthing options after previous caesarean | Yes (updated 2006) | Shorten, Wollongong, AU, 2000 | [email protected] or www.capersbookstore.com.au/product.asp?id=301 | |
| Measles mumps and rubella vaccination | Yes | University of Leeds, UK & NSIRS Australia | ||
| Bowel | Yes | Smith, Sydney, AU 2008 | sydney.edu.au/medicine/public‐health/shdg/resources/decision_aids.php | |
| Osteoarthritis of the hip and knee | No | Informed Medical Decisions Foundation and Health Dialog; USA | ||
| Colorectal cancer screening | Yes | Steckelberg, Hamburg, Germany | — | |
| Prostate cancer screening | Yes | Georgetown University Medical Center, Washington DC, USA, 2000 | Obtained from author | |
| Atrial fibrillation treatment | Yes | Thomson, Newcastle Upon Thyne, UK | Disc sent by mail | |
| Colorectal cancer screen | Yes | Trevena, Sydney, AU | sydney.edu.au/medicine/public‐health/shdg/resources/decision_aids.php | |
| Embryos transplant | Yes | Radboud University Nijmegen Medical Centre; 2006 | ||
| Cystic Fibrosis referral transplant | Yes | Aaron, Ottawa ON, CA, 2009 (last update 2011) | ||
| Breast cancer surgery | Yes | Vodermaier, Vancouver BC, CA | Received by email (in German) | |
| Prostate cancer screening | Yes | Informed Medical Decisions Foundation, MA, USA, 1999 | informedmedicaldecisions.org/imdf_decision_aid/deciding‐if‐the‐psa‐test‐is‐right‐for‐you/ | |
| Menorrhagia treatment | No | Vuorma, Helsinki Finland, 1996 | — | |
| Prostate cancer screening | Yes | Oxford, UK | Included in publication | |
| Diabetes mellitus type 2 treatment | Yes | Montori, Rochester MN, USA | ||
| Prostate cancer screening | Yes | Georgetown University, Washington, DC, USA | Obtained from author | |
| Breast cancer chemotherapy | Yes | Whelan, Hamilton CA, 1995 | Included in publication | |
| Breast cancer surgery | Yes | Whelan, Hamilton CA, 1997 | Included in publication | |
| Prostate cancer screening | Yes | Wolf, Charlottesville VA, USA, 1996 | Script in publication | |
| Colon cancer screening | Yes | Wolf, Charlottesville VA, USA, 2000 | Script in publication | |
| Pregnancy termination | No | Bekker, Leeds, UK, 2002 | — |
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Decision quality instrument, 19 items re knowledge (> 50%) | After 1st consultation with surgeon | 60 | 58.3% | 60 | 33.3% | P = 0.01 | |
| 12 true or false questions; scores ranging from −12 to 12 | Immediately post | 89 | 4.9 | 103 | 2.17 | P < 0.001 | |
| Insufficient (≤ 50% correct) | Immediately post | 383 | 31.8% | 102 | 93.1% | P < 0.001 | |
| Sufficient | Immediately post | 383 | 61.9% | 102 | 6.9% | — | |
| Open‐ended questions about medication options to reduce stroke ‐ knows medications | Postintervention | 66 | 61% | 62 | 31% | OR 3.5 (95% CI: 1.6 to 7.7, P = 0.001) | |
| Open‐ended questions about side effects of medications ‐ knows side effects | Postintervention | 53 | 49% | 46 | 37% | OR 1.9 (95%CI: 0.9 to 4.0; P = 0.07) | |
| 7‐item multiple choice knowledge test (unable to standardize results) | On discharge (˜ 1 month) | 49 | 15 (4.4 SD) | 58 | 10.9 (5.4 SD) | P = 0.01 | |
| 12‐item multiple choice | Pre‐operatively | 66 | 14%* | 67 | 8%* | *mean increase from baseline P = 0.02 | |
| (in consultation) | 13‐item questionnaire (median, IQR) total score | Immediately post | 32 | 7 (4.5 to 9.0) | 45 | 5.5 (2.5 to 8.0) | P = 0.11 |
| 9‐items knowledge based on decision aid | Immediately post | 32 | 6 (3.5 to 6.5) | 45 | 4 (2.0 to 8.0) | P = 0.01 | |
| 10‐item yes/no/unsure general knowledge test about natural health products (not specific to outcomes of options) | Change scores from baseline to 2 weeks | 43 | 0.86 ± 1.77 P = 0.002 | 41 | 0.51 ± 1.47 P = 0.031 | No difference between groups (P = 0.162) | |
| (in consultation) | 14‐item survey | Immediately post | — | — | — | — | No difference in level of knowledge between groups |
| Correctly answers question about best option to lower blood sugar | 6 months postintervention | 95 | 51.6% | 80 | 28.8% | P < 0.001 | |
| Correctly answers question about best option to lower complications | 6 months postintervention | 95 | 31.0% | 80 | 29% | P = 0.90 | |
| 9‐item ‐ 4 concept questions and 5 numeric questions | — | 351 | — | 357 | — | Significantly higher mean increase for the intervention group (2.62 ) compared to control group (0.68) from baseline, P < 0.001 | |
| 8‐item survey | 2‐week, 2‐month, and 6‐month follow‐ups | — | — | — | — | Intervention type had no impact on general or specific knowledge | |
| Good level knowledge was scored higher than the mid point of the knowledge scale (greater than 4) | — | — | — | — | — | 88% (147/167) in DA group compared to 72% (123/171) pamphlet group. OR 3.43 (95% CI 1.79 to 6.58) | |
| Ozanne 2007 (in consultation) | Change in knowledge from baseline | Post‐test | 15 | 48% to 64% | 15 | 45% to 57% | change in knowledge score was significant for decision aid (P = 0.01) but not control (P = 0.13) |
| 10‐item knowledge index score | 2 weeks | 308 | 7.44 | 290 | 6.9 | P = 0.001 | |
| 24‐items adapted from existing prostate cancer knowledge measures | Immediately post | 100 | — | 100 | — | The total mean standardized knowledge score was 84.38 (SD 12.38) | |
| Adequate knowledge (positive score: understanding benefits/harms) | 1 month | 134 | 28/134 | 137 | 8/137 | P = 0.0001 | |
| 12‐item true/false/don't know | Post‐test | 468 | 75% (range 0 to 100) | 522 | 25% (range 0 to 100) | P < 0.0001 | |
| Weymiller 2007 (in consultation) | 14‐item ‐ 9 addressed by decision aid; 5 were not | Immediately post | 52 | 46 | — | Mean difference between groups 2.4 (95% CI 1.5 to 3.3) P < 0.05 (when decision aid administered during the consultation only ‐ not if prior to the consultation) | |
| CI: confidence interval; DA: decision aid; OR: odds ratio; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Accuracy of stroke risk (reported by taking the absolute value of the difference between the participant's risk as estimated by the DA and the estimate provided by the participant ‐ out of 100; lower score indicates more accurate estimation of risk) | Postintervention | 69 | 9.1 (SD 13.3) | 66 | 14.2 (SD 13) | P = 0.002 | |
| Accuracy of bleeding risk (reported same as above) | Postintervention | 69 | 8.7 (SD 12.5) | 66 | 13.1 (SD 12.2) | P = 0.004 | |
| Expectation of benefit index 11 items score from 1 to 4 with lower score indicating better knowledge | Post (after reviewing DA) | 127 | 2.3 | 129 | 2.6 | P = 0.001 | |
| Correct estimate of amniocentesis miscarriage risk | 3‐6 months postintervention | 357 | 263 (73.8%) | 353 | 208 (59.0%) | P < 0.001 | |
| Correct estimate of Down syndrome risk | 3‐6 months postintervention | 357 | 210 (58.7%) | 353 | 163 (46.1%) | P = 0.001 | |
| 3 of 8 multiple choice items in the knowledge test (question 4, 5, 7) | 2 weeks post | — | — | — | — | Total knowledge reported only | |
| 5 item numerical questions (max = 5) | Post | 113 | 3.02 | 189 | 2.45 | P < 0.001 | |
| — | 2‐week, 2‐month, and 6‐month follow‐ups | — | — | — | — | Intervention type had no impact on risk perceptions | |
| 8 numerical questions (max = 8) | — | 357 | 2.93 (SD 2.91) | 173 | 0.58 (SD 1.28) | P < 0.001 | |
| Weymiller 2007 (in consultation) | — | Immediately | 52 | — | 46 | — | Difference between group OR 22.4 (95% CI 5.9 to 85.8) when decision aid administered during the consultation only (not if prior to) OR 6.7 (95% CI 2.2 to 19.7) when the decision aid administered prior to or during the consultation |
| CI: confidence interval; DA: decision aid; OR: odds ratio; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Percent match procedures described by Sepucha et al (2007; 2008). For values items were most predictive and used to specify logistic models to estimate predicted probability of selecting surgery > 0.5. | Postintervention | 75 | — | 77 | — | The intervention group experienced a more rapid early improvement in value concordance immediately after the intervention compared to control | |
| Concordant when men reported:a) sexual function influenced decision and they had radiation therapy; b) bowel function influenced decision and they had surgery; c) all effects influenced decision and they had surveillance | 6 months postintervention | 239 | — | 209 | — | No difference OR = 0.82; 95% CI 0.56 to 1.2 | |
| Concordance between participant's preferences and values for potential outcomes related to the decision and the choice made | within weeks | 155 | — | 151 | — | Men assigned to the decision aid who chose not to have a PSA test rated their concern about prostate cancer lower than did men who requested a PSA test. Men assigned to usual care provided similar ratings of concern about prostate cancer regardless of their PSA decision. There was no statistically significant difference between groups. | |
| — | — | — | — | — | — | Women valuing of non‐chemical aspect of natural health products was positively associated with their choice of nature health products, P = 0.006. No difference between groups | |
| Association between values and choice | — | — | — | — | — | No difference; between‐group differences were not reported | |
| Congruence between personal values and decision | 3 weeks | 70 | — | 70 | — | Patient choices were consistent with their values across both randomized groups | |
| DA: decision aid; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Total decisional conflict‐ change from baseline (standardised values) | Immediately post | 75 | Mean −20 SD 19.44 | 77 | Mean −11.8 SD 22.83 | P = 0.03 | |
| Decisional conflict scale | Uncertainty | — | −3.61 units | — | — | P = 0.04 | |
| Uninformed | — | — | — | — | No significant difference | ||
| Unclear values | — | −3.57 units | — | — | P = 0.002 | ||
| Unsupported | — | — | — | — | No significant difference | ||
| Ineffective decision | — | — | — | — | No significant difference | ||
| Total | — | −1.75 units | — | — | P = 0.07 | ||
| Decisional conflict scale | Immediately post | — | — | — | — | DCS was higher in the intervention group compared to control, P < 0.001. | |
| Decisional conflict ‐ subscales only | Feeling uninformed | 155 | 23.37 | 151 | 29.68 | P < 0.05 | |
| Feeling unclear values | 155 | 32.25 | 151 | 37.93 | P < 0.05 | ||
| Feeling supported | 155 | 30.51 | 151 | 35.21 | P < 0.05 | ||
| Feeling uncertain | 155 | — | 151 | — | No difference | ||
| Effective decisions | 155 | — | 151 | — | No difference | ||
| Decisional conflict (total score) | 4 months | 73 | 19 SD 14 | 81 | 22 SD 17 | No difference | |
| 10 months | 73 | 21 SD 17 | 81 | 18 SD 17 | No difference | ||
| Decisional conflict | Immediately after office visit | 196 | 1.54 | 75 | 1.58 | No difference | |
| LeBlanc 2015 (in consult) | Decision conflict (overall) median, IQR | Immediately post | 28 | 10.9 (95% CI 1.6 to 26.6) | 36 | 22.7 (95% CI 7.8 to 28.5) | P = 0.18 |
| Informed subscale | Immediately post | 28 | 4.2 (95% CI 0 to 25) | 36 | 20.8 (95% CI 0 to 33.3) | P = 0.14 | |
| Values subscale | Immediately post | 28 | 16.7 (95% CI 0 to 25) | 36 | 25.0 (95% CI 8.3 to 33.3) | P = 0.25 | |
| Support subscale | Immediately post | 28 | 8.3 (95% CI 0 to 25) | 36 | 16.7 (95% CI 0 to 25) | P = 0.35 | |
| Certainty subscale | Immediately post | 28 | 8.3 (95% CI 0 to 25) | 36 | 25 (95% CI 0 to 25) | P = 0.3 | |
| Effectiveness subscale | Immediately post | 28 | 12.5 (95% CI 0 to 25) | 36 | 18.8 (95% CI 0 to 25) | P = 0.15 | |
| Legare 2012 (in consult) | Decisional conflict ‐ proportion who had a value of 2.5 or more on the 1−5 DCS. (n,%) | Immediately post | 163 | 4.6% (95% CI 2.6 to 7.4) | 165 | 6.3% (95% CI 0 to 12.8) | Absolute difference 1.7; RR 0.8 (95% CI 0.2 to 2.4) |
| Decisional conflict scale median (range) | 1‐2 weeks postintervention | 107 | 26 (range 0‐79) | 100 | 26 (range 0‐67) | No difference | |
| Based on approaches suggested by Marteau et al. (informed choice) | Immediately after intervention | 91 | 71% | 110 | 64% | P = 0.24 | |
| Ozanne 2007 (in consult) | Decisional conflict | Postconsultation | 15 | — | 15 | — | Both groups showed lower decisional conflict postconsultation (P < 0.001) but no difference between groups |
| Decisional conflict | Immediately post | — | — | — | — | The total mean score was 24.5 with a SD of 15.25 (N = 200) | |
| Decisional conflict | 12 of 16 items of the original scale | — | — | — | — | Significant longitudinal impact of the decision aid was moderated by baseline decision status; decision aid led to significant decreases in decisional conflict for those who were undecided at the time of randomisation | |
| Thomson 2007 (in consult) | Decisional conflict | Postconsultation | 53 | — | 56 | — | Difference between decision aid and control group were −0.18 (95% CI −0.34 to −0.01). P = 0.036 |
| 3‐months post | 51 | — | 55 | — | Difference between decision aid and control group were −0.15 (95% CI −0.37 to 0.06), no significant difference | ||
| 15 item questionnaire (1‐5) ‐ satisfaction‐uncertainty | Postintervention, pre IVF | 124 | 72.5 | 128 | 75 | P = 0.76 | |
| 15 item questionnaire (1‐5) ‐ informed (includes some items from DCS) | Postintervention, pre IVF | 124 | 77.5 | 128 | 87.5 | P = 0.001 | |
| Weymiller 2007 (in consult) | Decisional conflict | Immediately post | 52 | — | 46 | — | Mean difference indicates statistically significantly lower decisional conflict for decision aid compared to usual care. Total DCS −10.6 (95% CI −15.4 to −5.9) Uncertain −12.8 (95% CI −18.4 to −7.3) Informed −17.3 (95% CI −22.6 to −12.0) if administered during consult −6.6 (95% CI −14.3 to −1.1) if administered prior to consult Values clarity −8.5 (95% CI−15.7 to −1.3) Support −9.4 (95% CI −14.8 to −3.9) Effective decision −10.0 (95% CI −15.0 to −5.0) |
| CI: confidence interval; DA: decision aid; DCS: decisional conflict scale; IVF: in vitro fertilisation; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Informed | Immediately post | 69 | 13.0 | 66 | 24.8 | P = 0.01 | |
| Values | Immediately post | 69 | 6.4 | 66 | 21.0 | P <.001 | |
| Total DCS | 2 week follow‐up | 357 | 13.63 (SD 20.55) | 173 | 14.91 (SD 18.34) | P = 0.02 | |
| Total DCS | Used 8 of 10 items only 1 month post | 80 | 24.1% high | 74 | 41.9% high | Results were dichotomized (items removed choosing without pressure from others; know what options are available to you) | |
| Total DCS | 2 months post | 153 | 27.5% | 136 | 38.2% | Significant decrease for DA group compared to usual care in the home condition site | |
| 13 months post | 153 | 38.6% | 136 | 31.6% | No difference | ||
| DA: decision aid; DCS: decisional conflict scale; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| SURE tool Item: 'Feels sure about the best choice' | Postintervention; prior to surgical consult | 65 | 72.3% | 66 | 80.3% | No difference | |
| 'Knows the benefits and harms . . .' | Postintervention; prior to surgical consult | 65 | 92.3% | 66 | 66.7% | No difference | |
| 'Clear about which benefits and harms . . .' | Postintervention; prior to surgical consult | 65 | 87.7% | 66 | 74.2% | No difference | |
| 'Has enough support and advice . . .' | Postintervention; prior to surgical consult | 65 | 76.9% | 66 | 77.3% | No difference | |
| Total SURE score | Postintervention; prior to surgical consult | 65 | 69.2% | 66 | 57.6% | No difference |
| Study | Scale used | Timing | N decision aid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Discussed risk of stroke | Immediately post | 69 | 71% | 66 | 12% | P < 0.001 | |
| Discussed risk of major bleeding | Immediately post | 69 | 69% | 66 | 20% | P < 0.001 | |
| Discussed feeding with physician, nurse clinician, or physician's assistant | 3 months | 126 | 46% | 127 | 33% | P = 0.04 | |
| Discussed feeding with other nursing home staff | 3 months | 126 | 64% | 127 | 71% | P = 0.42 | |
| Hess 2012 (in consult) | OPTION scale | Analysis of the consultation using video‐recordings | 101 | Mean 26.6% (95% CI 24.9 to 8.2) | 103 | Mean 7% (95% CI 5.9 to 8.1) | Significantly greater in the intervention arm |
| LeBlanc 2015 (in consult) | OPTION scale | Analysis of the consultation using video‐recordings | 25 | Mean 57% (95% CI 50 to 64) | 13 | Mean 43% (95% CI 37 to 48) | P = 0.001 |
| Discussed PSA testing with physician postintervention | 8 months postintervention | 215 | 15.8% | 216 | 8.3% | P < 0.001 | |
| Montori 2011 (in consult) | OPTION 100‐point scale | Analysis of the consultation using video‐recorded consultations | 38 | 49.8 | 32 | 27.3 | P < 0.001 |
| Mullan 2009 (in consult) | OPTION scale | Analysis of the consultation using video‐recorded consultations | 48 used decision aid within consultation | Mean 49.7% (SD 17.74) | 37 usual care | Mean 27.7% (SD 11.75) | MD 21.8 (95% CI 13.0 to 30.5) for decision aid vs usual care. All but 2 of the 12 items significantly favoured the decision aid |
| Discussed CHD with doctor | Patient reported Immediately post | 16/41 decision aid pre‐consult with summary report to bring to consult | — | 8/34 usual care | — | Absolute difference 16% (95% CI −4 to 37) | |
| Plan to reduce CHD risk and discussed with doctor | Patient reported Immediately post | 15/41 decision aid pre‐consult with summary report to bring to consult | — | 8/34 usual care | — | Absolute difference 13% (95% CI −7 to 34). | |
| Plan to reduce CHD risk and not discussed with doctor | Patient reported Immediately post | 37/41 decision aid pre‐consult with summary report to bring to consult | — | 25/34 usual care | — | Absolute difference 16% (95% CI −1 to 33) | |
| Had CHD discussion with provider | Patient reported Immediately post | 79 | 89% | 78 | 58% | Absolute difference 31% (95% CI 15 to 45; P < 0.001) | |
| Patient‐raised discussion | Patient reported Immediately post | 79 | 63% | 78 | 35% | Absolute difference 28% (95% CI 9 to 45; P = 0.02) | |
| Modified Healthcare Climate Questionnaire: 1. "My provider provided me with choices and options about lowering my chances of heart disease" | Patient reported Immediately post | 79 | 91% | 78 | 76% | Absolute difference 15% (95% CI −0.1 to 31; P = 0.02) | |
| 2. "My provider understands how I see things with respect to lowering my chances of heart disease." | Patient reported Immediately post | 79 | 95% | 78 | 86% | Absolute difference 9% (95% CI −7 to 25; P = 0.21) | |
| 3. "My provider conveyed confidence in my ability to make changes regarding lowering my chances of heart disease" | patient reported Immediately post | 79 | 88% | 78 | 77% | Absolute difference 11% (95% CI −5 to 27; P = 0.15) | |
| 4. "My provider encouraged me to ask questions" | Patient reported Immediately post | 79 | 78% | 78 | 67% | Absolute difference 11% (95% CI −4% to 27%; P = 0.13) | |
| 5. "My provider listened to how I would like to do things" | Patient reported Immediately post | 79 | 92% | 78 | 71% | Absolute difference 21% (CI 95% 6 to 37; P < 0.01) | |
| 6. "My provider tried to understanding how I see things before suggesting new ways to lower my chances of heart disease." | Patient reported Immediately post | 79 | 84% | 78 | 69% | Absolute difference 15% (CI 95% −0.3 to 31; P = 0.05) | |
| Weymiller 2007 (in consult) | OPTION Scale | Analysis of the consultation using video‐recorded consultations | 1/2 used decision aid prior to consult and 1/2 used it during consult | — | Usual care | — | Greater patient participation MD 4.4 (95% CI 2.9 to 6.0) in decision aid compared to usual care |
| CHD: coronary heart disease;CI: confidence interval; DA: decision aid; DCS: decisional conflict scale; ICC: intraclass correlation coefficient;MD: mean difference; OPTION scale: observing patient involvement scale; RR: risk ratio; SD: standard deviation | |||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Control preferences ‐ patients choosing active/collaborative decision making | Postintervention | 291 | 95% | 334 | 92% | No difference | |
| Control preferences did not change | Postintervention | 291 | 92% | 334 | 87% | No difference | |
| Control preferences changed to passive | Postintervention | 291 | 3% | 334 | 5% | No difference | |
| Control preferences changed to active/ collaborative | Postintervention | 291 | 3% | 334 | 7% | No difference | |
| COMRADE used to measure patients' perceived involvement in decisions | Postconsultation | 49 | 79.5 (SD 18.6) 76.8 (SD 20.9) | 58 | 69.7 (SD 20.0) 73.5 (SD 19.3) | Increased patient involvement in decision aid group postintervention compared to usual care at baseline. At discharge there was no difference between groups. | |
| Surrogates feeling somewhat or very involved in decision making | Postintervention | — | 83% | — | 77% | P = 0.18 | |
| Achieved decision involvement | Postintervention | — | 32% | — | 35% | No difference | |
| Loh 2007 (in consult) | Patients' perceived involvement in decision making | Postconsultation | 191 | 26.3 pre 28.0 post | 96 | 24.5 pre 25.5 post | Improved patient participation from baseline to post exposure to the decision aid (P = 0.010) and in comparison to the usual care group (P = 0.003) but there was no change in the control group for the pre‐post comparison |
| Adapted from the Control Preferences Scale | Postintervention | — | — | — | — | The total mean scores were: 2.74 (SD 1.25) (N = 99) pre and 2.83 (SD 1.16) (N = 199) post, no statistically significant difference | |
| Patient participation: 'Any' | Immediately post | 79 | 79% | 78 | 51% | Absolute difference 28% (95% CI 9 to 45; P = 0.01) | |
| 'None' | Immediately post | 79 | 21% | 78 | 49% | Absolute difference −28% (95% CI −45 to −9) | |
| Decision Evaluation scale (15 item questionnaire) Decision control subscale | Postconsultation | 124 | 85 | 128 | 87.5 | P = 0.33 | |
| DA: decision aid; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Single item ‐ ranging from '0 = completely undecided' to '100 = made my decision' | — | — | — | — | — | No difference | |
| Answer "I don't know" to question "I favor taking adjuvant radioactive iodine" | Immediately post ‐ treatment preference | 37 | 10.8% | 37 | 21.6% | — | |
| 6.3 months (mean) post ‐ actual decision | 37 | 13.5% | 37 | 8.1% | — | ||
| Answer "I don't know" to question "I favor not taking adjuvant radioactive iodine" | Immediately post ‐ treatment preference | 37 | 43.2% | 37 | 37.8% | — | |
| 6.3 months (mean) post ‐ actual decision | 37 | 40.5% | 37 | 51.4% | — | ||
| DA: decision aid | |||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| 1‐item; pleased with treatment choice | 1 month postsurgery | 62/66 | — | 55/67 | — | P = 0.03 | |
| Legare 2012 (in consult) | Single question Likert scale to assess the quality of the decision made (0 = very low quality; 10 = very high quality) | Immediately post | 162 | 8.54 (SD 1.56) | 159 | 8.53 (SD 1.51) | No difference; MD 0.0 (95% CI −0.4 to 0.4) |
| Satisfaction with decision scale: median (range) | 1 month postintervention | 107 | 22 (13‐25) | 100 | 21(15‐25) | No difference | |
| Scale: ranging from 1−7 and standardized out 100 | 4 weeks | — | 91.17 (SD 14) | — | 91.33 (SD 14.50) | No difference | |
| 6‐item | 1, 6, 12 months | 100 | — | 114 | — | Overall, no difference between groups; decision aid led to significantly increased satisfaction compared to usual care among those who were undecided at randomization but not among those who had made a decision before randomization; (only graph in paper with no raw data) | |
| Single item ‐ "Are you satisfied with your decision about prostate cancer testing? | 1 month | 80 | 79.7% | 74 | 75.7% | — | |
| Satisfaction with the decision | Immediately post | 134 | — | 137 | — | No difference (P = 0.56) | |
| 6‐item Satisfaction with Decision Scale | Baseline | — | > 95% | — | > 95% | — | |
| DA: decision aid. | |||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Satisfaction with the decision‐making process | |||||||
| Hess 2012 (in consult) | Satisfaction with decision process (0 for strongly agree to 5 for strongly disagree) | — | 101 | — | 103 | — | Patients in DA group reported greater satisfaction with the DM process (strongly agree, 61% DA vs 40% usual care) |
| Satisfied with process | 1 week follow‐up | 53 | 42 | 56 | 50 | High satisfaction with no difference by group | |
| Satisfaction with participating in decision making | |||||||
| Measured satisfaction with opportunities to participate in decision making using a single item | — | — | — | — | — | Compared to usual care, women who received the decision aid followed by nurse coaching were significantly more satisfied with the opportunities to participate in decision making (OR 1.5, 95% CI 1.1 to 2.0). | |
| Satisfaction with the information provided | |||||||
| LeBlanc 2015 (in consult) | Amount of information was just right | Postconsultation | 29 | 25 (86%) | 37 | 34 (92%) | P = 0.69 |
| Information received was clear | Postconsultation | 27 | 17 (63%) | 36 | 26 (72%) | P = 0.43 | |
| Information received was helpful | Postconsultation | 28 | 21 (75%) | 34 | 23 (68%) | P = 0.53 | |
| Would recommend method to others | Postconsultation | 28 | 24 (86%) | 35 | 27 (77%) | P = 0.52 | |
| Satisfaction with information received subscale 4‐item (0 to 100; low to high) | Average 10 days | 54 | 76 (15.5 SD) | 56 | 59 (23.3 SD) | P = 0.001 | |
| Montori 2011 (in consult) | (7 point scales) Participants' satisfaction with knowledge transfer
| Postintervention | 49 | 6.6 6 6 6.1 6.4 | 46 | 6.3 6 5.8 5.8 6.2 | P = 0.798 P = 0.296 P = 0.624 P = 0.248 P = 0.435 |
| Clinicians' satisfaction with knowledge transfer
| Postintervention | 39 | 5.8 6.1 5.9 | 33 | 5.2 4.9 4.8 | P = 0.006 P < 0.001 P < 0.001 | |
| Satisfaction with information about medicines | 4 months post | 16 | 10.4 (SD 2.9) | 17 | 10.1 (SD 2.2) | No difference | |
| Satisfaction with the clinician | |||||||
| Satisfaction with practitioner treatment during decision process subscale 4‐item (0 to 100; low to high) | Average 10 days | 54 | 69 (25.3 SD) | 56 | 54 (26.7 SD) | P = 0.004 | |
| Satisfaction with cancer information service 1‐item (1 to 5; low to high) | 2 weeks | — | 4.37 (0.84 SD) | — | 4.38 (0.86 SD) | No difference | |
| 6 months | — | 4.51 (0.75 SD) | — | 4.51 (0.64 SD) | No difference | ||
|
| 1 week follow‐up | 53 | 49 (92.5%) 47 47 44 36 | 56 | 53 (94.6%) 50 51 45 36 | High satisfaction with no difference by group | |
| DA: decision aid; SD: standard deviation. | |||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Preparation for Decision Making Scale | Pre‐consultation | 43 | 35 (median) | 40 | 20.5 (median) | P < 0.001 | |
| Preparation for Decision Making Scale item (5‐point scale from: 1 not at all to 5 a great deal) 'Help recognize decision to be made' | Postintervention; pre‐consultation | 66 | 4.12 (SD 1.21) | 64 | 3.78 (SD 1.25) | No difference | |
| Preparation for Decision Making Scale item 'Help know decision depends on what matters most' | Postintervention; pre‐consultation | 66 | 4.48 (SD 0.85) | 64 | 4.14 (SD 1.10) | No difference | |
| Preparation for Decision Making Scale item 'Help think about how involved you want to be in decision' | Postintervention; pre‐consultation | 66 | 4.48 (SD 0.81) | 64 | 4.25 (SD 1.05) | No difference | |
| Preparation for Decision Making Scale item 'Prepare you to talk to your doctor about what matters most' | Postintervention; pre‐consultation | 66 | 4.36 (SD 0.91) | 64 | 4.23 (SD 1.04) | No difference | |
| Preparation for Decision Making Scale | 3 weeks | 70 | 65.1 (SD 24.9) | 79 | 53.9 (SD 27.1) | P = 0.009 | |
| DA: decision aid; SD: standard deviation. | |||||||
| Study | Type of comparison | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| Surgery ‐ elective more minor surgery | ||||||
| Actual choice (feeding tube) | 127 | 1 | 129 | 3 | No difference | |
| Actual choice (abortion) | — | — | — | — | No difference | |
| Screening ‐ breast cancer genetic testing | ||||||
| Preference | — | — | — | — | Intervention decreased intention for genetic testing in women at average risk; increased in women at high risk | |
| Screening ‐ breast screening | ||||||
| Actual choice | — | — | — | — | No difference in women who participated in screening within 1 month | |
| Preference of women who were decided | 96 | 52% | 127 | 65% | P = 0.05 | |
| Screening ‐ cardiac stress testing | ||||||
| Hess 2012 (in consult) | Actual choice | 101 | 58% | 100 | 77% | P < 0.001 |
| Screening ‐ diabetes | ||||||
| Actual choice | 633 | 353 | 639 | 368 | P = 0.51 | |
| Preference | 273 | — | 134 | — | No difference | |
| Screening ‐ prenatal | ||||||
| Bekker 2004 (in consult) | Actual choice | — | — | — | — | No difference |
| Actual choice | — | — | — | — | No difference | |
| Screening ‐ prostate cancer testing | ||||||
| Actual choice | — | — | — | — | The experimental interventions led to significant reductions in requests for prostate‐specific antigen tests ( ˜2 times greater decline). | |
| Actual choice 2 years postintervention | 215 | 62.7% | 216 | 66.7% | No difference Exp (B) = 0.829 CI 95% 0.564 to 1.218 | |
| Actual choice | — | — | — | — | No difference (P > 0.3) | |
| Preference | 215 | 80.9% | 216 | 80.1% | No difference Exp (B) = 0.994 95% CI 0.614 to 1.610 | |
| Diagnostic testing ‐ prenatal genetic testing | ||||||
| Invasive diagnostic testing without screening test | 357 | 11 (3.0%) | 353 | 16 (4.6%) | P = 0.37 | |
| Screening test followed by invasive diagnostic test | 357 | 10 (2.9%) | 353 | 27 (7.7%) | Not reported | |
| Medication ‐ antibiotics for upper respiratory infections | ||||||
| Legare 2011 (in consult) | Actual choice | 81 | 33 | 70 | 49 | P = 0.08 |
| Legare 2012 (in consult) | Actual choice | — | 27.2% | — | 52.2% | Absolute difference 25.0; RR 0.5 (95% CI 0.3 to 0.7) |
| Medication ‐ atrial fibrillation anti‐thrombosis ‐ uptake | ||||||
| Actual choice | — | — | — | — | 25% decrease in DA group, not statistically significant | |
| Actual choice | — | — | — | — | No difference | |
| Thomson 2007 (in consult) | Actual choice | — | 93.8% | — | 25% | RR 0.27 (95% CI 0.11 to 0.63) |
| Medication ‐ breast cancer prevention | ||||||
| Actual choice | 383 | 0.5% | 102 | 0% | No difference | |
| Medication ‐ cardiovascular disease prevention | ||||||
| DA versus usual care. Any effective CHD risk reducing strategy | 79 | 63% | 78 | 42% | Absolute difference 21%, 95% CI 5 to 37 | |
| Blood pressure medication, if hypertensive (n = 55) | — | 26% | — | 29% | Absolute difference −3%, 95% CI −30 to 25 | |
| Cholesterol medication, if abnormal cholesterol (n = 69) | — | 39% | — | 9% | Absolute difference 30%, 95% CI 14 to 46 | |
| Smoking cessation, if smoking (n = 21) | — | 80% | — | 50% | Absolute difference 30%, 95% CI −16 to 76 | |
| Aspirin, if CHD risk > 6% (n = 140) | — | 43% | — | 24% | Absolute difference 19%, 95% CI −1 to 39 | |
| Diet low in saturated fat | 79 | 29% | 78 | 40% | Absolute difference −11%, 95% CI −27 to 6 | |
| Regular exercise | 79 | 53% | 78 | 54% | Absolute difference −1%, 95% CI −17 to 16 | |
| Medication ‐ chemotherapy | ||||||
| For advanced cancer | 107 | 77% | 100 | 71% | No difference | |
| Whelan 2003 (in consult) | For early breast cancer | — | — | — | — | No difference |
| Medication ‐ diabetes management insulin | ||||||
| Preference for insulin | 92 | 18.5% | 78 | 11.5% | P = 0.41 | |
| Medication ‐ hypertension | ||||||
| Uptake | — | — | — | — | No difference | |
| Medication ‐ menopausal symptom treatment | ||||||
| Uptake hormone therapy | — | — | — | — | 8% decrease in DA group, not statistically significant | |
| preference for natural health products | 41% | 41% | No difference | |||
| Medication ‐ multiple sclerosis immunotherapy | ||||||
| Uptake | — | — | — | — | No difference | |
| Medication ‐ osteoporosis | ||||||
| LeBlanc 2015 (in consult) | Preference | 29 | 12 (41%) | 38 | 11 (29%) | P = 0.57 |
| Prescription during encounter | 29 | 13 (41%) | 38 | 12 (27%) | P = 0.2 | |
| Montori 2011 (in consult) | Uptake | 52 | 44% | 48 | 40% | No difference |
| Mental health treatment | ||||||
| Uptake prescribed medication | — | — | — | — | No difference | |
| Uptake psychoeducation | — | — | — | — | Higher uptake in DA group (P = 0.003) | |
| Uptake of 9 psychoeducation sessions | 9 | 44% | 11 | 9% | All 4 decision aid participants received 9 or more sessions. 1 of 5 usual care received 9 or more sessions. | |
| Obstetrics ‐ birth control method | ||||||
| Preference | 114 | — | 108 | — | No difference in the methods chosen between groups, participants in the intervention group were not more likely to initiate the requested method immediately compared to those in | |
| Obstetric ‐ childbirth procedure | ||||||
| Uptake | — | — | — | — | No difference | |
| Uptake | — | — | — | — | No difference | |
| preference | — | — | — | — | No difference | |
| Obstetric ‐ embryo transplant | ||||||
| Van Peperstraten 2010 ‐ single embryo transfer | Uptake | 152 | 43% | 156 | 32% | P = 0.05 |
| Other‐ lung transplant referral | ||||||
| — | — | — | — | No difference | ||
| Other ‐ pre‐operative blood transfusion | ||||||
| Uptake | — | — | — | — | No difference | |
| Other ‐ pelvic organ prolapse treatment | ||||||
| Uptake | — | — | — | — | No difference; P = 0.835 | |
| Other ‐ thyroid cancer adjuvant radioactive iodine treatment | ||||||
| Preferred treatment Immediately post | 37 | 35.1% | 37 | 32.4% | — | |
| Uptake at follow‐up (˜ 6.3 months post) | 37 | 29.7% | 37 | 18.9% | No difference. (Chi2=1.18; df = 1; P = 0.28) | |
| Vaccines | ||||||
| Uptake flu shot | 48 | 46% | 59 | 27% | No difference | |
| Uptake hepatitis B | — | — | — | — | Significant increase of 76% in the DA group | |
| Measles, mumps, rubella in infant | 48 | 48 (100%) | 71 | 70 (99%) | No difference | |
| CHD: congenital heart disease;DA: decision aid; OR: odds ratio; RR: risk ratio. | ||||||
| Reference | Scale used | N decision aid | Mean (SD) Decision aid | N comparison | Mean (SD) Comparison | Notes |
| 3 months ‐ using a contraceptive method that was in the same effectiveness group as the method requested at enrolment, 'very effective', as chosen option ‐ e.g. if chose sterilization and ended up using an IUD counted as adhering | 48 | 85% | 52 | 77% | P = 0.28 No difference in adherence to baseline choice | |
| 3 months ‐ using a contraceptive method that was in the same effectiveness group, 'effective', as chosen option | 41 | 68% | 31 | 68% | P = 0.96 No difference in adherence to baseline choice | |
| LeBlanc 2015 (in consult) | Filled prescription (of those who were given prescriptions), n/N (%) | 29 | 10/13 (83%) (1 missing) | 38 | 4/12 (40%) (2 missing) | P = 0.07 No difference in adherence to baseline choice |
| % of days covered out of 180 (median, 95% CI) | 29 | 46.7% (95% CI 39.2 to 46.7) | 38 | 85% (95% CI 55.3 to 92.6) | P = 0.08 No difference in adherence to treatment | |
| Legare 2012 (in consult) | 2 weeks post ‐ single question asking if the patient maintained the decision made, n (%) | 163 | 143 (87.7%) | 165 | 150 (91.5%) | Absolute difference 3.8; RR 1.0 (95% CI 0.9 to 1.0) No difference in adherence to baseline choice |
| Congruence between intention to test and verified PSA test ‐ 1 year | 244 | 55.3% | 246 | 58.1% | No difference in adherence to baseline choice. 95% CI 0.62 to 1.28 | |
| Congruence between intention to test and verified PSA test ‐ 2 year | 244 | 59.0% | 246 | 59.3% | No difference in adherence to baseline choice. 95% CI 0.69 to 1.42 | |
| Loh 2007 (in consult) | 6‐8 weeks ‐ patient reported ‐ 5‐point Likert scale on steadiness of following the treatment plan: 1 = very bad to 5 = very good | 191 | 4.3 (0.9) | 96 | 3.9 (1.0) | No difference in adherence to treatment P = 0.073 |
| 6‐8 weeks ‐ physician reported ‐ 5‐point Likert scale steadiness of following the treatment plan: 1 = very bad to 5 = very good | 191 | 4.8 (0.6) | 96 | 4.3 (1.1) | No difference in adherence to treatment P = 0.56 | |
| Mann D 2010 (in consult) | 3 months ‐ telephone administration of the 8‐item Morisky adherence (7 yes/no items and 1 item with 5‐point Likert scale to elicit behaviours such as skipping medicines when they have no symptoms) | — | — | — | — | No difference in adherence to treatment 70% reported good adherence to statins; no difference between groups |
| 6 months ‐ telephone administration of the 8‐item Morisky adherence (7 yes/no items and 1 item with 5‐point Likert scale to elicit behaviours such as skipping medicines when they have no symptoms) | — | — | — | — | No difference in adherence to treatment 80% reported good adherence to statins; no difference between groups | |
| 6 months ‐ self‐reported – measured % of participants taking therapy initially chosen | 129 | 95.35% | 134 | 93.28% | No difference in adherence to baseline choice P = 0.44 | |
| 6 months ‐ Self‐reported. Measured % of patients who did not change their initially chosen treatment. | 95 | 68.1% | 80 | 56.3% | PtDA higher aderence to baseline choice P = 0.041 | |
| ˜ 3 years ‐ self‐reported – 6‐item adherence questionnaire: from 'I take all my tablets at the same time of day' to 'I take hardly any of my tablets' | — | — | — | — | No difference to adherence to baseline choice or adherence to treatment | |
| Montori 2011 (in consult) | 6 months ‐ percentage of participants that self‐reported currently taking medication who have not missed 1 dose within last week | 17 | 65% | 19 | 63% | No difference in adherence to treatment P = 0.92 |
| 6 months ‐ percentage of participants who opted to take bisphosphonates who took their medication on more than 80% of the days for which it was prescribed, based on pharmacy records | 23 | 100% | 19 | 74% | No difference in adherence to baseline choice P = 0.009 | |
| 4 months ‐ percentage of participants who engaged in psychotherapy sessions | 9 | 44% | 11 | 45% | — | |
| 4 months ‐ number of participants who engaged in 9 or more psychotherapy sessions | 4 | 100% | 5 | 20% | Adherence to treatment | |
| Mullan 2009 (in consult) | 6 months ‐ pharmacy records ‐ days covered (range) | 48 | 97.5% (range 0 to 100) | 37 | 100 (range 73.9 to 100) | Higher adherence to treatment for usual care AMD −8.88 (−13.6% to −4.14%) Statistically significant |
| 6 months ‐ self‐reported by telephone call – did not miss a dose in last week | 41 | 76% | 31 | 81% | No difference in adherence to treatment OR 0.74 (95% CI 0.24 to 2.32) | |
| 4 months ‐ extent to which the participants' behaviour in taking medications coincides with the clinical prescription | 16 | 10.4% (32) (improvement from baseline) | 17 | 2% (26) (improvement from baseline) | No difference in adherence to treatment | |
| 3 month ‐ adherence to treatment | ||||||
| Any therapy promoted in decision aid | 76 | 45 (59%) | 73 | 25 (34%) | P < 0.01 DA group showed higher adherence to treatment | |
| Any therapy promoted in decision aid + others (e.g. diet or physical activity) | 77 | 64 (83%) | 77 | 52 (68%) | P = 0.02 | |
| Aspirin | 32 | 30 (94%) | 19 | 11 (58%) | P < 0.01 | |
| Cholesterol medicine | 14 | 12 (86%) | 6 | 5 (83%) | The intervention had little effect blood pressure or cholesterol medication, | |
| Blood pressure medicine | 9 | 9 (100%) | 12 | 11 (92%) | ||
| Stop smoking | 8 | 25% | 5 | 20% | No effect on smoking, although subgroups were small | |
| 1 month ‐ faecal occult blood test uptake | 134 | 5.2% | 137 | 6.6% | No difference in adherence to baseline choice P = 0.64 | |
| Weymiller 2007 (in consult) | 3 months ‐ self‐reported – mailed surveys and telephone call to non‐respondents On adherence to statin use: missed 1 dose or more within the last week | 33 | 93.94% | 29 | 79.31% | No difference in adherence to baseline choice or treatment when analysis adjusted by sex, cardiovascular disease, and number of medications |
| AMD: absolute mean difference; DA: decision aid; OR: odds ratio | ||||||
| Reference | Timing | N decision aid | Mean Decision aid (SD) | Change from baseline | N comparison | Mean comparison (SD) | Change from Baseline | Notes |
| General health | ||||||||
| Barry 1997 (SF‐36) | Baseline | 104 | 67.2 (19.0) | — | 123 | 71.1 (17.6) | — | P = 0.02 |
| 3 months | — | — | −0.96 (1.41) | — | — | −3.59 (1.57) | ||
| 6 months | — | — | −1.46 (1.41) | — | — | −4.93 (1.45) | ||
| 12 months | — | — | 0.61 (1.58) | — | — | −4.99 (1.44) | ||
| Legare 2011 (percentage of people who felt they had a stable and better health, (SF‐12)) | 2 weeks post | Not reported | 94 | +7 | Not reported | 85 | −6 | P = 0.08 |
| Morgan 2000 (SF‐36) | 6 months post | 72 | 62 (23) | + 4.0 | 88 | 65 (20) | + 7.0 | No difference |
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 2.2 | 159 | — | 2.8 | No difference |
| Physical function | ||||||||
| Barry 1997 (SF‐36) | Baseline | 104 | 81.9 (20.0) | — | 123 | 83.0 (18.9) | — | P = 0.02 |
| 3 months | — | — | −0.34 (1.61) | — | — | −1.81 (1.07) | ||
| 6 months | — | — | 0.10 (1.28) | — | — | −3.26 (1.37) | ||
| 12 months | — | — | 0.15 (1.40) | — | — | −3.74 (1.18) | ||
| Knops 2014 (SF‐12) | Baseline | 91 | 45 | — | 87 | 44 | — | — |
| 1 month | 80 | 44 | — | 84 | 43 | — | — | |
| 4 months | 80 | 43 | — | 84 | 43 | — | — | |
| 10 months | 80 | 44 | — | 84 | 42 | — | — | |
| Legare 2012 (SF‐12) | 2 weeks post | 160 | 49.4 (SD 7.5) | + 0.08 | 162 | 48.16 (7.80) | + 0.43 | Absolute difference 1.2; MD 0.4 (95% CI−2.6 to 3.3) |
| Morgan 2000 (SF‐36) | 6 months post | 72 | 67 (29) | + 7.0 | 88 | 71 (24) | + 10.0 | No difference |
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 2.4 | 159 | — | 2.2 | No difference |
| Bernstein 1998 (SF‐12) | 3 months post | 61 | 38 (12.1) | + 0.6 | 48 | 37.6 (10.6) | + 3.8 | No difference |
| Social function | ||||||||
| Barry 1997 (SF‐36) | Baseline | 104 | 90.6 (15.5) | 123 | 91.7 (15.7) | P = 0.17 | ||
| 3 months | — | — | 0.34 (1.58) | — | — | −2.26 (1.36) | ||
| 6 months | — | — | −0.05 (1.92) | — | — | −2.46 (1.45) | ||
| 12 months | — | — | −1.46 (1.85) | — | — | −3.52 (1.71) | ||
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| McCaffery 2010 (SF‐36) | 2 weeks | 77 | 84.7 | — | 71 | 82.1 | — | P = 0.39 |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 5.2 | 159 | — | 7.1 | No difference |
| Mental function | ||||||||
| Legare 2012 (SF‐12) | 2 weeks post | 160 | 50.79 (SD 9.28) | −0.38 | 162 | 51.21 (8.36) | + 2.7 | Absolute difference 0.4; MD −1.9 (95% CI−4.9 to 1.1) |
| McCaffery 2010 (SF‐36) | 2 weeks | 77 | 71.3 | — | 71 | 71.6 | — | P = 0.46 |
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 4.7 | 159 | — | 5.3 | No difference |
| Bernstein 1998 (SF‐12) | 3 months post | 61 | 49.1 (11.4) | 0.0 | 48 | 48.9 (10.8) | + 0.9 | No difference |
| Role function | ||||||||
| Morgan 2000 (SF‐36) | 6 months post | 72 | 62 (44) | + 20.0 | 88 | 58 (43) | + 15.0 | No difference |
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | P = 0.04 |
| Vuorma 2003 (RAND‐36) | 1 year | — | 9.2 | — | — | 6.3 | No difference | |
| Bodily pain | ||||||||
| Morgan 2000 (SF‐36) | 6 months post | 72 | 81 (22) | + 6.0 | 88 | 77 (24) | + 5.0 | No difference |
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | 157 | — | No difference | ||
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 6.5 | 159 | — | 6.2 | No difference |
| Role emotional | ||||||||
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| McCaffery 2010 (SF‐36) | 2 weeks | 77 | 80.3 | — | 71 | 77.4 | — | P = 0.61 |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 12.6 | 159 | — | 1.9 | P = 0.01 |
| Energy/vitality | ||||||||
| Kennedy 2002 (SF‐36) | 2 years | 176 | — | — | 157 | — | — | No difference |
| McCaffery 2010 (SF‐36) | 2 weeks | 77 | 55.2 | — | 71 | 54.1 | — | P = 0.09 |
| Vuorma 2003 (RAND‐36) | 1 year | 156 | — | 8.9 | 159 | — | 8.8 | No difference |
| SF‐36 all dimensions | ||||||||
| McCaffery 2010 (SF‐36) | 2 weeks | 77 | 47 | — | 71 | 46.3 | — | P = 0.35 |
| Murray 2001b (SF‐36) | 9 months | 93 | — | — | 94 | — | — | No difference |
| Murray 2001a (SP−36) | 9 months | 54 | — | — | 48 | — | — | No difference |
| Health utilities | ||||||||
| Murray 2001a (Euroqol EQ‐5D) | — | — | — | — | — | — | — | No difference |
| Murray 2001b (Euroqol EQ‐5D) | — | — | — | — | — | — | — | No difference |
| Euroqol 5D ‐ Health Thermometer (scale of 0 to 100) | ||||||||
| Postconsultation | 29 | 85 (IQR 80, 95) | — | 85 (IQR 73, 90) | — | — | P = 0.19 | |
| DA: decision aid; SF‐36: Medical Outcomes Study 36‐item Short‐Form Health Survey; SF‐12: 12‐item Short‐Form Health Survey; RAND‐36: the 36‐item short form survey from the RAND Medical Outcomes Study | ||||||||
| Study | Outcome | Scale used | Timing | N decision aid | Decision aid mean change (SD) | N comparison | Comparison mean change (SD) | Notes |
| Urinary symptoms | AUA Symptom Index (0 to 100) | 3 months | 104 | −4.80% (1.74) | 117 | −1.40% (1.37) | No difference; trend toward DA | |
| Urinary symptoms | AUA | 6 months | 104 | −3.66% (2.06) | 117 | −3.17% (1.77) | No difference | |
| Urinary symptoms | AUA | 12 months | 104 | −2.51% (2.11) | 117 | −4.14% (1.66) | No difference; trend toward control | |
| Impact of symptoms | BPH Impact Index (0 to 100) | 3 months | 104 | −6.58% (1.10) | 117 | −3.00% (1.05) | No difference; trend toward DA | |
| Impact of symptoms | BPH | 6 months | 104 | −4.37% (1.32) | 117 | −3.89% (1.16) | No difference; trend toward DA | |
| Impact of symptoms | BPH | 12 months | 104 | −5.53% (1.32) | 117 | −2.63% (1.32) | No difference; trend toward DA | |
| Satisfaction | SAQ (0 to 100) | 3 months | 61 | + 6.2% | 48 | + 10.5% | Control significantly more satisfied | |
| Angina stability | SAQ | 3 months | 61 | + 17.2% | 48 | + 28.3% | No difference | |
| Angina frequency | SAQ | 3 months | 61 | + 5.5% | 48 | + 15.3% | No difference | |
| Disease Perception | SAQ | 3 months | 61 | + 14.1% | 48 | + 18.8% | No difference | |
| Physical Capacity | SAQ | 3 months | 61 | −0.5% | 48 | + 7.1% | No difference | |
| (FACT‐G) median (range) | Functional status at 1 month post | 74 | 17 (6‐28) | — | 68 | 17.5 (7‐28) | — | P = 0.02 |
| Physical function at 1 month post | 74 | 21 (0‐28) | — | 68 | 20 (4‐28) | — | No difference | |
| Role emotional at 1 month post | 74 | 17 (0‐20) | — | 68 | 17(7‐20) | — | No difference | |
| Urinary symptoms | AUA symptom Index (0 to100) | — | — | — | — | — | No difference | |
| Menopausal symptoms | MenQol | — | — | — | — | — | No difference | |
| Menorrhagia specific utility scale | (0 to 100) | 6 months | 60 | 59.3 (30.0) | 56 | 50.9 (25.1) | P = 0.03 higher menorrhagia quality of life favouring DA group | |
| Inconvenience due to menstrual bleeding | (5 to 25) | 1 year | 156 | 10.4 | 159 | 10.5 | No difference | |
| Menstrual pain | (0 to 12) | 1 year | 156 | 4.7 | 159 | 4.6 | No difference | |
| AUA: American Urological Association; BPH: benign prostatic hyperplasia; DA: decision aid; SAQ: Seattle Angina Questionnaire; FACT‐G: Functional Assessment of Cancer Therapy‐General. | ||||||||
| Study | Outcome | Scale used | Timing | N decision aid | Decision aid outcome | N comparison | Comparison outcome | Notes |
| Death | — | 5 years | 104 | 41 (39%) | 106 | 33 (31%) | No difference | |
| Disease‐free survival | — | 10 years | 104 | 74 (70.8%) | 106 | 66 (62.5%) | P = 0.14 | |
| Biochemical failure (rising serum PSA) | — | 5 years | 100 | 42 (42%) | 96 | 34 (35%) | P = 0.57 | |
| Disease progression | — | 5 years | 97 | 31 (32%) | 92 | 28 (30%) | P = 0.94 | |
| Postoperative mortality | — | 10 months | 91 | 0 (0%) | 87 | 0 (0%) | ||
| Postoperative major morbidity | — | 10 months | 91 | 0 (0%) | 87 | 2 (6%) | P = .23 | |
| Aneurysm rupture during watchful waiting | — | 10 months | 91 | 0 (0%) | 87 | 3 (8%) | P = 0.12 | |
| HbA1c (change from baseline) | — | 6 months | 95 | −0.37% | 80 | −0.24% | P = 0.12 | |
| No angina | CCVA | 6 months | 72 | + 49% | 88 | + 48% | No difference | |
| Class I angina | CCVA | 6 months | 72 | −1% | 88 | + 6% | No difference | |
| Class II angina | CCVA | 6 months | 72 | −23% | 88 | −26% | No difference | |
| Class III angina | CCVA | 6 months | 72 | −26% | 88 | −28% | No difference | |
| Class IV angina | CCVA | 6 months | 72 | 0% | 88 | 0% | No difference | |
| Strokes or bleeds requiring admission | — | 3 months | 51 | — | 55 | — | No strokes and no bleeds requiring admission. 1 bleed and 1 transient stroke both in control group that required GP consultation | |
| Ongoing pregnancies (> 12 weeks gestation) | — | After 1st IVF cycle | 152 | — | 156 | — | 32% of participants in the intervention group and 38% of participants in the control group had ongoing pregnancies, P = 0.25 | |
| Twin pregnancies (> 12 weeks gestation) | — | After 1st IVF cycle | 152 | — | 156 | — | 4% of participants in intervention group and 6% of participants in control group had twin pregnancies, P = 0.33 | |
| Inconvenience due to menstrual bleeding | (5 to 25) | 1 year | 156 | 10.4 | 159 | 10.5 | No difference | |
| Menstrual pain | (0 to 12) | 1 year | 156 | 4.7 | 159 | 4.6 | No difference | |
| AUA: American Urological Association; CCVA: Canadian Cardiovascular Angina; BPH: benign prostatic hyperplasia; DA: decision aid; SAQ: Seattle Angina Questionnaire. | ||||||||
| Study | Timing | N decision aid | Mean decision aid (SD) | Change from baseline | N comparison | Mean comparison(SD) | Change from baseline | Notes |
| State Anxiety Inventory: < 30 days postintervention (standardized scores) | ||||||||
| Bekker 2004; prenatal screening | Immediately post | 50 | 58.9 (16.6) | — | 56 | 61.2 (13.7) | — | No difference |
| Evans 2010; PSA screening | Immediately post‐DA | 89 | 4.98 | — | 103 | 4.88 | — | No difference P = 0.98 |
| Fraenkel 2012; atrial fibrillation | Immediately post‐DA | 69 | 13.0 | — | 66 | 13.4 | — | No difference P =0.48 |
| Post consult, 1‐2 weeks and 4 weeks post | — | — | — | — | — | — | No difference | |
| Mathieu 2007; mammography screening | Immediately after | 321 | 29.61 | — | 315 | 29.34 | — | No difference |
| McCaffery 2010; HPV screening (state trait anxiety inventory) | 2 weeks | 77 | 10.5 | — | 71 | 10.6 | — | No difference P = 0.25 |
| Montgomery 2003; hypertension | Immediately post‐DA | 44 | 35.45 (10.52) | — | 50 | 37.67 (13.92) | — | No difference |
| Montgomery 2007; previous cesarean section | 37 weeks gestation | 196 | 38.7 (12.2) | — | 195 | 42.1 (12.2) | — | P = 0.016 |
| Nassar 2007; breech presentation | 1 week | 98 | 41.4 (12.5) | — | 90 | 44.4 (13.9) | — | No difference |
| Protheroe 2007; menorrhagia | 2 weeks | 59 | 11.6 (3.7) | — | 61 | 12.2 (3.7) | — | P = 0.016 |
| Rubel 2010; PSA screening | Immediately after 20 items adapted from state portion of State‐Trait Anxiety Inventory Scale STAI ‐ Form Y; | — | — | — | — | — | — | No difference Mean score = 1.66 (SD 0.59) (N = 200) for both groups |
| Smith 2010; bowel cancer screening | 2‐week follow‐up | 357 | 13.67 | — | 173 | 14.05 | — | No difference P = 0.80 |
| Thomson 2007; anti‐thrombotic treatment for atrial fibrillation | Immediately after | 53 | — | — | 56 | — | — | Significant fall in anxiety (−4.57) but no difference between groups (P = 0.98) |
| Trevena 2008 colorectal cancer screening | Immediately after | 134 | — | — | 137 | — | — | No difference (P = 0.59) |
| Van Peperstraten 2010; number of embryos transferred | Immediately after | 152 | 27.33% | — | 156 | 24.5% | — | No difference P = 0.14 |
| Whelan 2004; breast cancer surgery | 7 days post‐DA | 94 | 42.3 (1.3) | — | 107 | 41.9 (1.3) | — | No difference |
| Whelan 2003; breast chemotherapy | 7 days post‐DA | 82 | 45.6 | + 2.2 | 93 | 47.4 | + 0.8 | No difference |
| Wong 2006; pregnancy termination | Immediately post | 154 | 54 (15.8) | — | 159 | 54 (16.1) | — | No difference |
| State Anxiety Inventory: 1 month postintervention (standardized scores) | ||||||||
| Bekker 2004; prenatal screening | 1 month post‐DA | 29 | 35.3 (12.5) | — | 39 | 34.7 (14.8) | — | No difference |
| Davison 1997; prostate cancer treatment | 5‐6 weeks post‐DA | 30 | 35.5 | −9.0 | 30 | 34.5 | −2.5 | No difference |
| State Anxiety Inventory: 3 months postintervention (standardized scores) | ||||||||
| Murray 2001a; benign prostatic hypertrophy | 3 months post‐DA | 55 | 36.36 (14.99) | +2.4 | 48 | 32.08 (9.836) | +0.7 | No difference |
| Murray 2001b; hormone replacement therapy | 3 months post‐DA | 93 | 38.42 (10.83) | −0.5 | 95 | 40.53 (12.96) | +1.8 | No difference |
| Nagle 2008; prenatal screening | ˜1 to 12 weeks post‐DA | 167 | 37.2 (12.1) | — | 171 | 37.36 (12.6) | — | No difference |
| Nassar 2007; breech presentation | 3 months post‐DA | 86 | 29.2 (9.9) | — | 84 | 30.8 (10.5) | — | No difference |
| Vuorma 2003; menorrhagia treatment | 3 months post‐DA | 184 | 37.1 | +1.0 | 179 | 35.9 | −1.0 | No difference |
| Whelan 2003; breast chemotherapy | 3 months post‐DA | 82 | 36.0 | — | 93 | 37.8 | — | No difference |
| State Anxiety Inventory: 6 months postintervention (standardized scores) | ||||||||
| Lepore 2012; prostate screening | 8 months post‐DA | 215 | 9.6 (10.3) | — | 216 | 10.3 (10.2) | — | No difference No condition by time interaction on anxiety. Low in both groups. |
| Protheroe 2007; menorrhagia | 6 months post‐DA | 47 | 11.2 (4.2) | — | 52 | 13.3 (4.9) | — | No difference P = 0.067 |
| Whelan 2004; breast cancer surgery | 6 months post‐DA | 94 | 39.3 (1.3) | — | 107 | 38.9 (1.6) | — | No difference |
| Whelan 2003; breast chemotherapy | 6 months post‐DA | 82 | 38.2 | — | 93 | 38.2 | — | No difference |
| State Anxiety Inventory: 12 months postintervention (standardized scores) | ||||||||
| Whelan 2004; breast cancer surgery | 12 months post‐DA | 94 | 37.5 (1.4) | — | 107 | 36.6 (1.5) | — | No difference |
| Whelan 2003; breast chemotherapy | 12 months post‐DA | 82 | 39.2 | — | 93 | 40.2 | — | No difference |
| Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) | ||||||||
| Knops 2014; asymptomatic abdominal aortic aneurysm | 1 month post‐DA ‐ (HADS standardized) | 81 | 21.0 (17.1) | — | 85 | 23.8 (19.1) | — | No difference P = 0.73 |
| 4 months post‐DA (HADS) | 81 | 20.0 (19.1) | — | 85 | 21.9 (17.6) | — | — | |
| 10 months post‐DA (HADS) | 81 | 20.5 (20.0) | — | 85 | 21.4 (20.5) | — | — | |
| Lam 2013; breast cancer surgery | 1 week post‐DA Hospital Anxiety and Depression Scale (HADS standardized | 101 | 25.2 (22.4) | — | 97 | 24.8 (23.3) | — | No difference P = 0.655 |
| 1 month postsurgery | 101 | 11.9 (15.2) | — | 97 | 12.4 (15.7) | — | No difference P = 0.859 | |
| 4 months postsurgery | 91 | 10.5 (15.2) | — | 88 | 10.0 (14.8) | — | No difference P = 0.908 | |
| 10 months postsurgery | 88 | 12.9 (16.8) | — | 90 | 13.3 (17.1) | — | No difference P = 0.553 | |
| Other measures indicating anxiety | ||||||||
| Chabrera 2015; prostate cancer | Seeking and using social support | 61 | 22.3 (5.20) | + 7.8 | 61 | 16.2 (5.44) | + 1.8 | P < 0.001 |
| Focusing on the positive | 61 | 15.1 (6.93) | + 0.3 | 61 | 16.2 (9.47) | + 0.9 | P < 0.001 | |
| Behavioural escape‐avoidance | 61 | 23.7 (5.53) | + 4.5 | 61 | 22.0 (4.22) | + 1.2 | P < 0.001 | |
| Cognitive escape avoidance | 61 | 11.7 (5.37) | + 4.47 | 61 | 10.5 (4.65) | + 1.84 | P < 0.001 | |
| Distancing | 61 | 8.75 (3.90) | + 1.85 | 61 | 8.54 (4.28) | + 0.47 | P < 0.001 | |
| Fraenkel 2012; atrial fibrillation | Worry about having a stroke over next 5 years (10 point scale ‐ lower scores=less worry) | 69 | 1.8 (SD 1.7) | — | 66 | 1.6 (SD 1.6) | — | P = 0.47 |
| Worry about having a bleed over next 5 years (10 point scale ‐ lower scores = less worry) | 69 | 1.5 (SD 3.3) | — | 66 | 1.9 (SD 3.2) | — | P = 0.24 | |
| Johnson 2006; endodontic treatment | Immediately post ‐ single question 7‐point Likert scale | 32 | 3.2 (1.7) | — | 35 | 3.8 (2.1) | — | P = 0.27 |
| Lewis 2010; colorectal cancer screening | Intrusive thoughts ‐ 3 items; 4 point scale ‐ not at all | 139 | 66.2% | — | 157 | 68.0% | — | P = 0.92 |
| Intrusive thoughts ‐ 3 items; 4 point scale ‐ sometimes | 66 | 31.4% | — | 69 | 29.9% | — | ||
| intrusive thoughts ‐ 3 items; 4 point scale ‐ often | 5 | 2.4% | — | 5 | 2.2% | — | ||
| Intrusive thoughts ‐ measured using 1 item from the impact of events scale | 77 | 43% | — | 71 | 32% | — | No difference | |
| Worry about developing bowel cancer ‐ quite or very | 357 | 6% | — | 173 | 8% | — | P = 0.78 | |
| Worry about developing bowel cancer ‐ none or a bit | 357 | 94% | — | 173 | 92% | — | ||
| DA: decision aid; HPV: human papilloma virus; PSA: prostate‐specific antigen. | ||||||||
| Study | Timing | N decision aid | Mean decision aid (SD) | Change from baseline | N comparison | Mean comparison (SD) | Change from Baseline | Notes |
| Davison 1997 (20‐item CES‐D) | 5‐6 weeks | 30 | 29.8 | −0.6 | 30 | 29.5 | + 1.3 | No difference |
| Lam 2013 (Hospital and Anxiety Depression Scale) | 1 week post‐DA | 101 | 16.7 (17.1) | — | 97 | 16.7 (19.5) | — | No difference P = 0.849 |
| 1 month postsurgery | 101 | 11.0 (12.9) | — | 97 | 11.0 (12.9) | — | No difference P = 0.649 | |
| 4 months postsurgery | 91 | 10.0 (15.7) | — | 88 | 9.0 (11.4) | — | No difference P = 0.637 | |
| 10 months postsurgery | 88 | 6.7 (9.0) | — | 90 | 11.9 (16.2) | — | P = 0.001 | |
| Loh 2007 (Brief Patient Health Questionnaire‐D) | 6 to 8 weeks | 191 | 29.8 (2.7) | — | 96 | 27.0 (3.6) | — | No difference P = 0.236 |
| Nagle 2008 (Edinburgh Postnatal Depression Scale) | ˜1‐12 weeks post‐DA | 167 | 19 (11.6) | — | 171 | 19 (11.2) | — | No difference |
| Van Peperstraten 2010 (Beck Depression Inventory) | After multifaceted intervention/ before IVF | 126 | 16 (13%) | — | 136 | 5 (4%) | — | P = 0.01 |
| At uptake of IVF | 147 | 16 (11%) | — | 151 | 113 (9%) | — | No difference | |
| Whelan 2004 (20‐item CES‐D) | 1 week post‐DA | 94 | 13.8 (1.0) | — | 107 | 13.4 (1.1) | — | No difference |
| 6 months post‐DA | 94 | 15.1 (1.1) | — | 107 | 14.2 (1.2) | — | No difference | |
| 12 months post‐DA | 94 | 13.2 (1.3) | — | 107 | 12.8 (1.2) | — | No difference | |
| CES‐D: Centre for Epidemiology Studies Depresion Scale; DA: decision aid; IVF: in vitro fertilization. | ||||||||
| Author | Item | N decision aid | Proportion or mean (SD) | N control | Proportion or mean (SD) | Notes |
| Decision Regret Scale at 3 months postchoice | 28 | 12.1 (18.5) | 26 | 10 (20.1) | No difference P = 0.969 | |
| 5‐item Decisional Regret Index | 126 | 11.9 | 127 | 14.3 | No difference P = 0.14 | |
| Decision Regret Scale (out of 100) at 3‐6 months postintervention | 357 | 8.29 (12.5) | 353 | 6.83(10.8) | No difference P = 0.12; 95% CI 1.46 (−0.36 to 3.29) | |
| Decision Regret Scale at 1 month postsurgery | 101 | 21.4 (17.2) | 97 | 23.1 (18.3) | No difference Adjusted P = 1.0 | |
| Decision Regret Scale at 4 months postsurgery | 91 | 18.8 (15.8) | 88 | 24.4 (18.9) | P = 0.026 | |
| Decision Regret Scale at 10 months postsurgery | 88 | 20.1 (14.5) | 90 | 24.6 (18.8) | P = 0.014 | |
| Proportion of patients with decisional regret | — | 7% | — | 9% | No difference P = 0.91 | |
| Decision Regret Scale 2 weeks postconsultation | 162 | 12.38(19.08) | 164 | 7.59 (13.67) | No clinically significant difference; Absolute difference 4.8; MD 4.8 (95% CI 0.9 to 8.7) | |
| Decision Regret Scale at 6 months postintervention | 95 | 44.63 | 80 | 44.57 | No difference P = 0.872 | |
| DA: decision aid. | ||||||
| Study | Scale used | Timing | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Notes |
| 11‐item self‐efficacy scale | Postintervention | 291 | 83% (SD 40.26) | 334 | 79% (SD 33.08) | No difference | |
| Decisional self‐efficacy | Changes from baseline | 75 | + 3.0 (95% CI 0.6 to 5.4) | 77 | + 2.8 (95% CI 0.9 to 4.8) | No difference P = 0.78 | |
| Mean confidence with decision: scale from 1 (low confidence) to 5 (high confidence) | Postintervention | 48 | 4 | 59 | 3.6 | P = 0.02 | |
| Decisional self‐efficacy scale | Pre‐consultation | 43 | 32 (median) | 40 | 27 (median) | P = 0.001 | |
| Perceived ability to make an informed choice 1‐item; 5‐point Likert scale | 3 days post | 106 | — | 108 | — | P = 0.008; DA group more likely to agree that they could make an informed choice about PSA screening | |
| Perceived ability to make an informed choice 1‐item; 5‐point Likert scale | Immediately post | 131 | — | 136 | — | No difference | |
| Confidence with ability to understand outcomes of hormone therapy, make a decision, engage in discussion with practitioner, 3 items (0 to 10; low to high confidence) | 1 month post | 273 | 78% (18% SD) | 284 | 70% (19% SD) | P < 0.001 | |
| 9 months post | 261 | 80% (17%SD) | 278 | 75% (20% SD) | P = 0.0004 | ||
| 3 items adapted from the Decisional self‐efficacy scale | 2‐week follow‐up | 357 | 4.67 (0.54 SD) | 173 | 4.61 (0.62 SD) | No difference P = 0.26 | |
| CI: confidence interval; DA: decision aid; SD: standard deviation. | |||||||
| Study | Scale used | N decisionaid | Decision aid ‐ mean | N comparison | Comparison ‐ mean | Difference between groups | Notes |
| Consultation length | |||||||
| Bekker 2004 (in consultation) | Consultation length using DA in the consultation (minutes) | 50 | 32.2 (SD 13.0) | 56 | 26.3 (SD 11.5) | + 5.9 minutes | P = 0.01 (longer with decision aid) |
| Consultation length with practitioner post‐DA (minutes) | 61 | 20.9 (SD 6.8) | 62 | 21.0 (SD 7.2) | −0.1 minutes | No difference; P = 0.91 | |
| Time spent discussing prostate cancer with practitioner post‐DA (minutes) ‐ patient reported | 196 | 5.3 | 75 | 5.2 | + 0.1 minutes | No difference between groups | |
| Time spent discussing prostate cancer with practitioner post‐DA (minutes) ‐ physician reported | 196 | 3.8 | 75 | 4.2 | −0.4 minutes | No difference between groups but physicians thought they spent less time than patients (P < 0.001) | |
| LeBlanc 2015 (in consultation) | Consultation length with practitioner using DA in consultation (median, range in minutes) | 29 | 11.5 (5.4 to 21.4) | 37 | 10.7 (2.5 to 54.9) | + 0.8 minutes (−33.6 to 3.0) | — |
| Loh 2007 (in consultation) | Consultation length using DA in consultation (minutes) | 191 | 29.2 (10.7) | 96 | 26.7 (12.5) | +2.5 minutes | P = 0.681 |
| Ozanne 2007 (in consultation) | Consultation length using DA in consultation (minutes) | 15 | 24 | 15 | 21 | +3 minutes | P = 0.42 |
| Thomson 2007 (in consultation) | Consultation length using DA in consultation (minutes) | 8 | 44 (39 to 55) | 10 | 21 (19 to 26) | +23 minutes | P = 0.001 Compared computerized decision aid with standard gamble within the consultation to guideline driven consultation |
| Consultation length with practitioner post‐DA | |||||||
| 5 to 10 min | 53 | 6 (11.3%) | 54 | 5 (9.3%) | — | P = 0.91 | |
| 10 to 15 min | 17 (32.1%) | 19 (35.2%) | — | ||||
| 15 to 25 min | 15 (28.3%) | 14 (25.9%) | — | ||||
| 25 to 35 min | 7 (13.2%) | 5 (9.3%) | — | ||||
| Above 35 min | 8 (15.1%) | 11 (20.4%) | — | ||||
| Whelan 2003 (in consultation) | Consultation length using DA in consultation (minutes) | 50 | 68.3 | 50 | 65.7 | + 2.6 minutes | P = 0.53 |
| Weymiller 2007 (in consultation) | Consultation length using DA in consultation (minutes) | 52 | — | 46 | — | + 3.8 minutes in DA group | Not statistically significant 3.8 min (95% CI −2.9 to 10.5) |
| Cost and resource use | |||||||
| Total costs in the UK for decision about mode of delivery post previous cesarean | 235 | GBP 2019 (SD 741) | 238 | GBP 2033 (SD 677) | — | No difference | |
| Cost‐effectiveness in the UK for decision about benign heavy menstruation | 296 300 | USD 2026 (DA alone) USD 1556 (DA plus nurse coaching | 298 | USD 2751 | — | Mean differences: DA versus usual care USD 461 (95% CI 236 to 696) DA plus coaching versus usual care USD 1184 (95% CI 684 to 2110) | |
| Total costs excluding intervention in the UK for decision about treatment of benign enlarged prostate | 57 | GBP 310.3 (SD 602.0) | 48 | GBP 188.8 (SD 300.4) | — | Mean difference GBP 121.5 (95% CI −58.9 to 302.0) | |
| Total costs including intervention (interactive video disk equipment) in the UK for decision about treatment of benign enlarged prostate | 57 | GBP 594.10 (SD 602) | 48 | GBP 188.8 (SD 300.4) | — | Mean difference GBP 405.4 (95% CI GBP 224.9 to GBP 585.8) P < 0.001 | |
| Total costs excluding intervention in the UK for decision about hormone replacement therapy | 85 | GBP 90.5 | 84 | GBP 90.9 (SD 39.2) | — | No difference | |
| Total costs including intervention (interactive video disk equipment) in the UK for decision about hormone replacement therapy | 85 | GBP 306.5 (SD 42.8) | 84 | GBP 90.9 (SD 39.2) | — | Mean difference GBP 215.5 (95% CI 203.1 to 228.0) P < 0.001 | |
| Mean total savings per couple in the Netherlands for decision about embryo transfer for invitro fertilization | — | — | — | — | — | Mean total saving per couple in the intervention group were EUR 169.75 (USD 219.12) | |
| Total estimated costs in Finland for treatment decision about heavy benign menstruation | 184 | EUR 2760 | 179 | EUR 3094 | — | P = 0.1 No difference between intervention and control | |
| Resource use | |||||||
| Legare 2012 (in consultation) | Repeat consultation for the same reason, n (%) | 163 | 37 (22.7%) | 165 | 25 (15.2%) | Absolute difference 7.5 | RR 1.3 (95% CI 0.7 to 2.3) |
| Thomson 2007 (in consultation) | GP consultations postintervention | 51 | 39 (76.5%) | 54 | 32 (59.3%) | — | P = 0.35 |
| Hospital appointments postintervention | 51 | 29 (56.9%) | 54 | 10 (18.5%) | — | P = 0.06 | |
| Wait time from screening of eligibility to decision | |||||||
| Wait time in weeks | 69 | 33.4 weeks | 71 | 33 weeks | — | No difference | |
| CI: confidence interval; DA: decision aid; RR: risk ratio; SD: standard deviation. | |||||||
| Outcome | Overall mean effect (95% CI), 105 total studies | Without trials having high risk of bias on at least 1 of 7 criteria (N = 16) |
| Knowledge | 13.27 (95% CI 11.32 to 15.25) 52 studies | 13.43 (95% CI 11.37 to 15.49) 47 studies |
| Accurate risk perceptions ‐ with probabilities versus no probabilities | 2.10 (95% CI 1.66 to 2.66) 17 studies | 2.02 (95% CI 1.57 to 2.59) 15 studies |
| Values congruent with chosen option | 2.06 (95% CI 1.46 to 2.91) 10 studies | 2.06 (95% CI 1.46 to 2.91) 10 studies |
| Uninformed subscale of Decisional Conflict Scale | −9.28 (95% CI −12.20 to −6.36) 27 studies | −9.96 (95% CI −13.13 to −6.78) 25 studies |
| Unclear values subscale of Decisional Conflict Scale | ‐8.81 (95% Ci −11.99 to −5.63) 23 studies | −9.55 (95% CI −13.08 to −6.02) 21 studies |
| CI: confidence interval. | ||
| Outcome | Overall effect | Treatment decision | Screening decision | Video/computer decision aid | Audio/pamphlet Decision aid | Base risk control | Removal of outliers* |
| Knowledge ‐ decision aid versus usual care | 15.2 (11.7 to 18.7) | 16.5 (11.9 to 21.2) | 13.1 (7.7 to 18.5) | 21.3 (16.3 to 26.2) | 11.9 (8.3 to 15.6) | 15.5 (11.3 to 19.8) | 17.3 (13.6 to 20.9) (*Bekker 2004, Gattellari 2003, Johnson 2006) |
| Accurate risk perceptions ‐ probabilities versus no probabilities | 1.6 (1.4 to 1.9) | 1.6 (1.4 to 1.9) | 1.6 (1.1 to 2.3) | No data | 1.6 (1.4 to 1.9) | 1.3 (1.2 to 1.5) (P = 0.3) | 1.5 (1.3 to 1.7) (*Gattellari 2003) |
| Uninformed subscale of the Decisional Conflict Scale ‐ decision aid versus usual care | −8.4 (−11.9 to −4.8) | −9.4 (−13.3 to −5.5) | −3.5 (−12.9 to 5.8) | −12.6 (−19.5 to −5.8) | −4.9 (−7.6 to −2.3) (P = 0.06) | −5.4 (−7.7 to −3.2) (P = 0.11) | −6.2 (−8.4 to −4.1) (P = 0.06) (*Montgomery 2003) |
| Unclear values subscale of the Decisional Conflict Scale ‐ decision aid versus usual care | −6.3 (−10.0 to −2.7) | −6.0 (−9.8 to −2.3) | Insufficient data | −8.0 (−15.1 to −1.0) | −4.5 (−8.4 to −0.6) | −3.6 (−6.8 to −0.5) | −4.0 (−6.7 to −1.3) (*Montgomery 2003) |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Knowledge ‐ all studies Show forest plot | 52 | 13316 | Mean Difference (IV, Random, 95% CI) | 13.27 [11.32, 15.23] |
| 2 Knowledge ‐ subgroup by timing of intervention (in consultation versus in preparation for consultation) Show forest plot | 52 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2.1 In consultation | 8 | 922 | Mean Difference (IV, Random, 95% CI) | 10.57 [4.79, 16.36] |
| 2.2 In preparation for consultation | 44 | 12394 | Mean Difference (IV, Random, 95% CI) | 13.77 [11.61, 15.93] |
| 3 Knowledge ‐ studies without high risk of bias Show forest plot | 47 | 12327 | Mean Difference (IV, Random, 95% CI) | 13.43 [11.37, 15.49] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Accurate risk perceptions ‐ all studies Show forest plot | 17 | 5096 | Risk Ratio (M‐H, Random, 95% CI) | 2.10 [1.66, 2.66] |
| 2 Accurate risk perceptions ‐ subgroup by timing of intervention (in consultation versus in preparation for consultation) Show forest plot | 17 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 2.1 In consultation | 6 | 898 | Risk Ratio (M‐H, Random, 95% CI) | 1.79 [1.28, 2.52] |
| 2.2 In preparation for consultation | 11 | 4198 | Risk Ratio (M‐H, Random, 95% CI) | 2.25 [1.65, 3.07] |
| 3 Accurate risk perceptions ‐ studies without high risk of bias Show forest plot | 15 | 4732 | Risk Ratio (M‐H, Random, 95% CI) | 2.02 [1.57, 2.59] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Informed values‐choice congruence ‐ all studies Show forest plot | 10 | 4626 | Risk Ratio (M‐H, Random, 95% CI) | 2.06 [1.46, 2.91] |
| 2 Informed values‐choice congruence ‐ actual choice only Show forest plot | 8 | 4154 | Risk Ratio (M‐H, Random, 95% CI) | 2.13 [1.44, 3.14] |
| 3 Informed values‐chose congruence ‐using MMIC Show forest plot | 8 | 4365 | Risk Ratio (M‐H, Random, 95% CI) | 2.08 [1.40, 3.08] |
| 4 Informed values‐chose congruence ‐ heterogeneous measures Show forest plot | 2 | 261 | Risk Ratio (M‐H, Random, 95% CI) | 2.02 [1.44, 2.83] |
| 5 Informed values‐choice congruence ‐ without studies of high risk of bias Show forest plot | 10 | 4626 | Risk Ratio (M‐H, Random, 95% CI) | 2.06 [1.46, 2.91] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Decisional conflict ‐ all studies Show forest plot | 42 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.1 Total decisional conflict score | 38 | 8785 | Mean Difference (IV, Random, 95% CI) | ‐7.22 [‐9.12, ‐5.31] |
| 1.2 Uninformed subscale | 27 | 5707 | Mean Difference (IV, Random, 95% CI) | ‐9.28 [‐12.20, ‐6.36] |
| 1.3 Unclear values subscale | 23 | 5068 | Mean Difference (IV, Random, 95% CI) | ‐8.81 [‐11.99, ‐5.63] |
| 1.4 Uncertainty subscale | 28 | 6200 | Mean Difference (IV, Random, 95% CI) | ‐4.04 [‐6.27, ‐1.81] |
| 1.5 Unsupported subscale | 24 | 5214 | Mean Difference (IV, Random, 95% CI) | ‐6.27 [‐8.86, ‐3.68] |
| 1.6 Ineffective choice subscale | 24 | 5241 | Mean Difference (IV, Random, 95% CI) | ‐6.31 [‐8.93, ‐3.70] |
| 2 Decisional conflict ‐ in consultation Show forest plot | 6 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 2.1 Uncertainty subscale | 2 | 310 | Mean Difference (IV, Random, 95% CI) | ‐6.45 [‐18.29, 5.38] |
| 2.2 Uninformed subscale | 4 | 545 | Mean Difference (IV, Random, 95% CI) | ‐6.37 [‐14.58, 1.85] |
| 2.3 Unclear values subscale | 1 | 204 | Mean Difference (IV, Random, 95% CI) | ‐17.2 [‐23.77, ‐10.63] |
| 2.4 Unsupported subscale | 2 | 354 | Mean Difference (IV, Random, 95% CI) | ‐7.16 [‐13.28, ‐1.03] |
| 2.5 Ineffective choice subscale | 2 | 307 | Mean Difference (IV, Random, 95% CI) | ‐2.37 [‐7.31, 2.58] |
| 2.6 Total decisional conflict score | 5 | 735 | Mean Difference (IV, Random, 95% CI) | ‐6.46 [‐12.78, ‐0.14] |
| 3 Decisional conflict ‐ in preparation for consultation Show forest plot | 36 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.1 Uncertainty subscale | 26 | 5890 | Mean Difference (IV, Random, 95% CI) | ‐3.83 [‐6.12, ‐1.55] |
| 3.2 Uninformed subscale | 23 | 5162 | Mean Difference (IV, Random, 95% CI) | ‐9.81 [‐13.00, ‐6.61] |
| 3.3 Unclear values subscale | 22 | 4864 | Mean Difference (IV, Random, 95% CI) | ‐8.40 [‐11.59, ‐5.21] |
| 3.4 Unsupported subscale | 22 | 4860 | Mean Difference (IV, Random, 95% CI) | ‐6.18 [‐8.96, ‐3.40] |
| 3.5 Ineffective choice subscale | 22 | 4934 | Mean Difference (IV, Random, 95% CI) | ‐6.75 [‐9.59, ‐3.90] |
| 3.6 Total decisional conflict score | 33 | 8050 | Mean Difference (IV, Random, 95% CI) | ‐7.32 [‐9.35, ‐5.28] |
| 4 Decisional conflict ‐ without studies having high risk of bias Show forest plot | 39 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 4.1 Uncertainty subscale | 26 | 5809 | Mean Difference (IV, Random, 95% CI) | ‐4.53 [‐6.87, ‐2.18] |
| 4.2 Uninformed subscale | 25 | 5316 | Mean Difference (IV, Random, 95% CI) | ‐9.96 [‐13.13, ‐6.78] |
| 4.3 Unclear values subscale | 21 | 4677 | Mean Difference (IV, Random, 95% CI) | ‐9.55 [‐13.08, ‐6.02] |
| 4.4 Unsupported subscale | 22 | 4823 | Mean Difference (IV, Random, 95% CI) | ‐7.00 [‐9.76, ‐4.24] |
| 4.5 Ineffective choice subscale | 22 | 4850 | Mean Difference (IV, Random, 95% CI) | ‐6.97 [‐9.76, ‐4.18] |
| 4.6 Total decisional conflict score | 35 | 8240 | Mean Difference (IV, Random, 95% CI) | ‐7.81 [‐9.84, ‐5.77] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Participation in decision making ‐ all studies Show forest plot | 16 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1 Clinician‐controlled decision making | 16 | 3180 | Risk Ratio (M‐H, Random, 95% CI) | 0.68 [0.55, 0.83] |
| 1.2 Patient‐controlled decision making | 15 | 3009 | Risk Ratio (M‐H, Random, 95% CI) | 1.28 [1.05, 1.55] |
| 1.3 Shared decision making | 15 | 2973 | Risk Ratio (M‐H, Random, 95% CI) | 0.95 [0.83, 1.10] |
| 2 Participation in decision making ‐ in consultation Show forest plot | 3 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 2.1 Clinician‐controlled decision making ‐ in consultation | 3 | 650 | Risk Ratio (M‐H, Random, 95% CI) | 0.89 [0.70, 1.12] |
| 2.2 Patient‐controlled decision making ‐ in consultation | 2 | 479 | Risk Ratio (M‐H, Random, 95% CI) | 1.01 [0.80, 1.27] |
| 2.3 Shared decision making ‐ in consultation | 2 | 479 | Risk Ratio (M‐H, Random, 95% CI) | 1.14 [0.84, 1.55] |
| 3 Participation in decision making ‐ in preparation for consultation Show forest plot | 13 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 3.1 Clinician‐controlled decision making | 13 | 2530 | Risk Ratio (M‐H, Random, 95% CI) | 0.60 [0.48, 0.75] |
| 3.2 Patient‐controlled decision making | 13 | 2530 | Risk Ratio (M‐H, Random, 95% CI) | 1.37 [1.08, 1.73] |
| 3.3 Shared decision making | 13 | 2494 | Risk Ratio (M‐H, Random, 95% CI) | 0.94 [0.80, 1.09] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Proportion undecided ‐ all studies Show forest plot | 22 | 5256 | Risk Ratio (M‐H, Random, 95% CI) | 0.64 [0.52, 0.79] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Satisfaction with the choice ‐ all studies Show forest plot | 11 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 2 Satisfaction with the choice ‐ in consultation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3 Satisfaction with the choice ‐ in preparation for consultation Show forest plot | 10 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 4 Satisfaction with the decision making process ‐ all studies Show forest plot | 9 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 5 Satisfaction with the decision making process ‐ in consultation Show forest plot | 1 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 6 Satisfaction with the decision making process ‐ in preparation for consultation Show forest plot | 8 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Choice: surgery over conservative option Show forest plot | 18 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.1 Per‐protocol analysis | 18 | 3286 | Risk Ratio (M‐H, Random, 95% CI) | 0.87 [0.75, 1.01] |
| 1.2 Intention‐to‐treat analysis | 18 | 3844 | Risk Ratio (M‐H, Random, 95% CI) | 0.86 [0.75, 1.00] |
| 1.3 Per‐protocol analysis without prophylactic mastectomy | 17 | 3108 | Risk Ratio (M‐H, Random, 95% CI) | 0.84 [0.73, 0.97] |
| 2 Choice for screening Show forest plot | 25 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 2.1 PSA screening | 10 | 3996 | Risk Ratio (M‐H, Random, 95% CI) | 0.88 [0.80, 0.98] |
| 2.2 Colorectal cancer screening | 10 | 4529 | Risk Ratio (M‐H, Random, 95% CI) | 1.12 [0.95, 1.31] |
| 2.3 Breast cancer genetic testing | 3 | 738 | Risk Ratio (M‐H, Random, 95% CI) | 0.99 [0.71, 1.38] |
| 2.4 Prenatal diagnostic testing | 2 | 1100 | Risk Ratio (M‐H, Random, 95% CI) | 0.99 [0.91, 1.09] |
| 3 Choice: diabetes medication (uptake new medication) Show forest plot | 4 | 447 | Risk Ratio (M‐H, Random, 95% CI) | 1.65 [1.06, 2.56] |
