title: Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters.
abstract: OBJECTIVE
  To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes.
  
  
  METHODS
  Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions.
  
  
  RESULTS
  Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD = 23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p = 0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter.
  
  
  CONCLUSIONS
  Clinicians' fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended.
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Wyatt
authors.forename: Megan E
authors.initials: ME
authors.lastname: Branda
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Anderson
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Pencille
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First St, SW, Rochester, MN, USA. LeBlanc.Annie@mayo.edu.
authors.forename: Annie
authors.initials: A
authors.lastname: LeBlanc
mesh_terms: D000367:Age Factors; D000368:Aged; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D012959:Socioeconomic Factors