Table 2 Summary of findings attributes of the decision process: results in intervention group (IG) as compared with control group (CG) (n = 17)a
From: Decision aids to help older people make health decisions: a systematic review and meta-analysis
Short title | Decisional conflictc | Patient-provider communication | Participation in decision making | Satisfaction | Other process outcomes |
|---|---|---|---|---|---|
Davison (1997) [28] | n.m. | n.m. | More active role in treatment decision making (assumed by participants)b | n.m. | n.m. |
Dolan (2002) [29] | Less decisional conflict (total)b In particular: • No difference in uncertainty b • Better informedb • Better clarity of valuesb • More effective decision makingb • No difference in support b | n.m. | Increase in SDM (vs no increase in SDM in CG). Majority of patients who preferred a SDM process felt that the actual SDM process was consistent with this preference (vs half of the CG patients)b | n.m. | n.m. |
Fraenkel (2007) [30] | n.m. | n.m. | Greater decisional self-efficacy (i.e. self-confidence in abilities to participate in SDM). Greater preparedness to participate in SDM. Note: older adults (≥75) may be among the most likely to benefit. | n.m. | n.m. |
Fraenkel (2012) [31] | • Better informedb • Better clarity of valuesb | More frequent discussion of risk of stroke and risk of major bleeding. | n.m. | n.m. | n.m. |
Hanson (2011) [32] | Less decisional conflict for surrogates (total)b In particular: • Less uncertaintyb • More effective decision makingb • Better score on “factors contributing to uncertainty”b | Increased communication about feeding options with providers (i.e. more feeding discussions with physician, nurse practitioner or physician’s assistant). No differences in discussions with other nursing home staff. | Aa higher proportion felt involved in feeding decisions (83 % vs 77 %) but the difference was not significant. | No differences in satisfaction with decision-making | n.m. |
Jones (2009) [33] | Less decisional conflict (total) when the decision aid was delivered during the visit by the clinician (IG2), but this difference was not significant. | n.m. | n.m. | n.m. | n.m. |
Kaner (2007) [34] | n.m. | Duration: Computer-based decision aids (IG1 and IG2) significantly prolonged the consultations. Non-verbal behavior: More nodding, smiling and tool-directed gaze in both IGs, and less head-shaking and pointing to patients. | n.m. | n.m. | n.m. |
Man-Son-Hing (1999) [35] | No differences in decisional conflict (total) b In particular: • No difference in uncertainty b • Better informedb • No difference in clarity of values b • No difference in effective decision making b • No difference in support b | n.m. | No differences in participation in decision making b | No differences in satisfaction with the decision-making process. | n.m. |
Mathers (2012) [36] | Less decisional conflict (total)b In particular: • Less uncertaintyb • Better informedb • Better clarity of valuesb • More effective decision makingb • No difference in support b | n.m. | More autonomy in decision-making about treatment (IG patient was 1.23 times more likely to make an autonomous decision than CG patient). A smaller proportion in the IG described their decision as ‘passive’ or ‘collaborative’.b | n.m. | n.m. |
Mathieu (2007) [37] | No differences in total decisional conflict b In particular: • No difference in uncertainty b • Better informedb • Better clarity of valuesb • No difference in effective decision making b • No difference in support b | n.m. | n.m. | n.m. | No differences in attitudes towards screening. |
McAlister (2005) [38] | Less decisional conflict (total)b In particular: • Less uncertaintyb • Better informedb • Better clarity of valuesb • More effective decision making (trend p = .09)b • No difference in support b | n.m. | n.m. | n.m. | n.m. |
Montori (2011) [39] | No differences in decisional conflict (total) b | n.m. | Observed patient involvement in SDM was approximately double in IG than in CG. | No differences in satisfaction with knowledge transfer (according to patients). Greater satisfaction with knowledge transfer in the IG group, particularly ‘helpfulness of the information’, ‘would want other decisions’, ‘recommend to others’ (according to clinicians). Improved quality of the decision making process, particularly ‘patients’ informed choice’, ‘provider expects patients to stick with the decision’ and ‘provider believes patient is satisfied with the decision’ (according to clinicians). | No differences in trust in clinician (according to patients). |
Partin (2004) [40] | n.m. | IG2 (pamphlet) subjects were more likely than controls to discuss screening with their provider, but IG1 (video) subjects were not. | n.m. | n.m. | n.m. |
Stirling (2012) [42] | Less decisional conflict (total) according to authors (however not statistically significant, possibly due to small sample size)b In particular: • No difference in uncertainty. • No difference in feeling informed. • No difference in clarity of values. • No difference in effective decision making. • No difference in support. | n.m. | n.m. | n.m. | n.m. |
Street (1995) [43] | n.m. | No difference between IG and CG on patient-provider communication, and no interaction between age/education and intervention. In both groups, college-educated patients younger than 65 years of age were more active participants in the consultations than were older, less educated patients (i.e. asked questions more frequently, offered opinions, and expressed concerns). | No difference in involvement in decision making (self-reported) and no interaction between age/education and intervention. | n.m. | n.m. |
Thomson (2007) [44] | Less decisional conflict (total) immediately after the clinic. In particular: • No difference in uncertainty. • Better informed. • Better clarity of values. • No difference in effective decision making. • No difference in support. No difference in decisional conflict subscales at three months. | n.m. | n.m. | n.m. | n.m. |
Weymiller (2007) [48] | No significant differences in postvisit decisional conflict (total). In particular: • No difference in uncertainty. • Better informed, particularly when the clinician delivered the intervention during the visit (IG2). • No difference in clarity of values. • More effective decision making. • No difference in support. At 3 months, participants in the IG continued to have less decisional conflict than the IG, but these differences were no longer statistically significant. | n.m. | n.m. | n.m. | n.m. |