BMC Med Inform Decis Mak - Establishing the effectiveness of patient decision aids: key constructs and measurement instruments.

Tópicos

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Resumo

CKGROUND: Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness.METHODS: This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration's review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required.RESULTS: The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs.CONCLUSIONS: Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.

Resumo Limpo

ckground establish effect patient decis aid ptda requir evid ptdas improv qualiti decisionmak process qualiti choic made decis qualiti aim paper review theoret empir evid ptda effect discuss emerg practic research issu measur effectivenessmethod updat overview incorpor examin instrument use measur five key decisionmak process construct ie recogn decis feel inform option outcom feel clear goal prefer discuss goal prefer health care provid involv decis decis qualiti construct ie knowledg realist expect valueschoic agreement within trial cochran review b summari cochran collabor review ptdas key construct data construct instrument use extract independ two author trial disagr resolv discuss adjud third parti requiredresult studi provid consider evid ptdas improv decisionmak process decis qualiti major studi measur least one key decisionmak process decis qualiti construct seventeen differ measur instrument use measur decisionmak process construct singl instrument cover five construct decision conflict scale common use n follow control prefer scale n mani studi report one construct decis qualiti includ knowledg n realist expect risk benefit n valueschoic agreement n consider variabl valueschoic agreement defin determin studi report key decisionmak process decis qualiti constructsconclus evid ptda effect improv qualiti decisionmak process decis qualiti strong grow howev consensus standard measur either decisionmak process decis qualiti addit work need develop evalu measur instrument explor theoret issu advanc futur research ptda effect

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