BMC Med Inform Decis Mak - Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence.

Tópicos

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Resumo

CKGROUND: Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts "coaching" and "guidance"; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design.METHODS: We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care.RESULTS: Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs.CONCLUSIONS: Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.

Resumo Limpo

ckground coach guidanc structur approach can use within alongsid patient decis aid ptdas facilit process decis make coach provid individu guidanc embed within decis support materi purpos paper present updat definit concept coach guidanc b present updat summari current theoret empir insight role play coachingguid context ptdas c highlight emerg issu research opportun aspect ptda designmethod identifi literatur publish sinc share decis make theoret framework inclus coach guidanc also conduct subanalysi random control trial includ cochran collabor review ptdas search result updat decemb subanalysi conduct characterist coach andor guidanc includ trial ptdas trial allow impact coach andor guidanc ptda compar anoth intervent usual careresult theoret evid continu justifi use coach andor guidanc better support patient process think decis communic valuesprefer other random control trial ptdas trial includ coach trial provid guidanc compar usual care coach provid alongsid ptda improv knowledg decreas mean cost impact outcom eg particip decis make satisfact option chosen variabl trial show posit effect trial report differ valueschoic agreement decision conflict adher anxieti differ group none outcom wors patient expos decis coach alongsid ptda trial evalu effect guidanc provid within ptdasconclus theoret evid continu justifi use coach andor guidanc better support patient particip decis make howev random control trial compar effect coach use alongsid ptdas ptdas without coach trial compar ptdas guidanc without guidanc

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