The updated Cochrane Collaborative review of 86 randomized control trials (in six countries), involving 34 decisions, set out to determine how well decision aids prepare people to participate in decisions that involve weighing benefits, harms and scientific uncertainty. What the authors found was that decision aids not only improve the individual’s knowledge of their options, including the benefits and harms of those options, but decision aids also assist people in reaching choices that are more consistent with their informed values, while fostering collaboration with their provider.
The updated review builds upon the 2009 Cochrane Collaborative review that analyzed 55 randomized controlled trials. New findings in this updated review include evidence that decision aids improve informed values-based choices and appear to have a positive effect on patient-practitioner communication. The review also indicated that use of decision aids reduced the choice of major elective surgery by 20%.
Although the reduction of utilization rates may shed some light on a systemic issue of overuse across medical procedures when patients aren’t informed and involved in decision choices, the data also showed that this is not always the case when it comes to particular treatment decisions. For example, two trials (Murray 2001; Barry 1997) using the same decision aid for BPH surgery, showed a reduction in surgery in the US where baseline rates were higher, and an increase in surgery in the UK, where baseline rates were lower. “Perhaps shared decision making (SDM) is a way to find the ‘right rate’ for procedures,” says Dr. Michael J. Barry, president of the Informed Medical Decisions Foundation and co-author of the updated review.