Evidence-Based Medicine: Patient Decision Making

Decision aids:

1. Explicitly state the decision that needs to be considered;
2. Provide evidence-based information about a health condition, the options, associated benefits, harms, probabilities, and scientific uncertainties;
3. Help patients to recognize the values-sensitive nature of the decision and to clarify the value they place on the benefits, harms, and scientific uncertainties.
4. Must be updated regularly with the latest evidence.

They are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. They are an intervention that can be used to present evidence.

Decision aids can be used when:

• there is more than one reasonable option,
• when no option has a clear advantage, and
• when each option has benefits and harms that patients may value differently.

When patients use decision aids they:

1. improve their knowledge of the options;
2. feel more informed and more clear about what matters most to them
3. have more accurate expectations of possible benefits and harms of their options
4. participate more in decision making.

Decision aids appeared to have a positive effect on patient-practitioner communication.

From: Stacey, D et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014 Jan 28; CD001431.

Patients vary in how much they want to know about their condition, how much they are ready to commit to change, and what is important to their lifestyle to list just a few factors. Smith's book (below) discusses how to address such value-based issues during the patient-physician consultation. Decision aids should also take them into account when assisting decisions on selecting care.