Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis.
OBJECTIVE
To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS).


METHODS
Five electronic databases (to July 2006) and personal contacts (to December 2006).


RESULTS
Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion. Measures of decision quality were knowledge scores (27 trials), accurate risk perceptions (12 trials), and value congruence with the chosen option (3 trials). PtDAs improved knowledge scores relative to usual care (weighted mean difference [WMD] = 15.2%, 95% confidence interval [CI] = 11.7 to 18.7); detailed PtDAs were somewhat more effective than simpler PtDAs (WMD = 4.6%, 95% CI = 3.0 to 6.2). PtDAs with probabilities improved accurate risk perceptions relative to those without probabilities (relative risk = 1.6, 95% CI = 1.4 to 1.9). Relative to simpler PtDAs, detailed PtDAs improved value congruence with the chosen option. Only 2 of 6 IPDAS decision process criteria were measured: feeling informed (15 trials) and feeling clear about values (13 trials). PtDAs improved these process measures relative to usual care (feeling uninformed WMD = -8.4, 95% CI = -11.9 to -4.8; unclear values WMD = -6.3, 95% CI = -10.0 to -2.7). There was no difference in process measures when detailed and simple PtDAs were compared.


CONCLUSIONS
PtDAs improve decision quality and the decision process's measures of feeling informed and clear about values; however, the size of the effect varies across studies. Several IPDAS decision process measures have not been used. Future trials need to use a minimum data set of IPDAS evaluation measures. The degree of detail PtDAs require for positive effects on IPDAS criteria should be explored.
O'Connor
Annette M
AM
Ottawa Health Research Institute, Canada. ohdec@ohri.ca
Bennett
Carol
C
Stacey
Dawn
D
Barry
Michael J
MJ
Col
Nananda F
NF
Eden
Karen B
KB
Entwistle
Vikki
V
Fiset
Valerie
V
Holmes-Rovner
Margaret
M
Khangura
Sara
S
Llewellyn-Thomas
Hilary
H
Rovner
David R
DR
D003299:Cooperative Behavior; D020000:Decision Support Systems, Clinical / Q000592:standards*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D010353:Patient Education as Topic; D010358:Patient Participation; D016032:Randomized Controlled Trials as Topic