title: Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis.
abstract: 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.
authors.affiliation: Ottawa Health Research Institute, Canada. ohdec@ohri.ca
authors.forename: Annette M
authors.initials: AM
authors.lastname: O'Connor
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.forename: Dawn
authors.initials: D
authors.lastname: Stacey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.forename: Nananda F
authors.initials: NF
authors.lastname: Col
authors.forename: Karen B
authors.initials: KB
authors.lastname: Eden
authors.forename: Vikki
authors.initials: V
authors.lastname: Entwistle
authors.forename: Valerie
authors.initials: V
authors.lastname: Fiset
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.forename: Sara
authors.initials: S
authors.lastname: Khangura
authors.forename: Hilary
authors.initials: H
authors.lastname: Llewellyn-Thomas
authors.forename: David R
authors.initials: DR
authors.lastname: Rovner
mesh_terms: 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