Benefits of using decision aids highlighted in updated Cochrane review

By Rebecca Jenkins

Decision aids help patients make more informed healthcare choices and do not substantially lengthen consultation times, an updated Cochrane review finds.

In the latest version of the landmark review, first published in 2003 and last updated in 2017, researchers added 104 newly published randomised controlled trials comparing outcomes when patients were offered decision aids versus usual care.

In the 209 studies, involving 107,698 participants, patient decision aids were used in 71 different scenarios most often for decisions about cardiovascular treatments, cancer screening and treatments, mental health treatments and joint replacement surgery, researchers wrote.

The use of decision aids resulted in people having better knowledge and more accurate risk perceptions, the review found.

Patients also felt more informed and had a clearer match between their values and the healthcare option they chose.

People were more actively engaged in decision making with clinicians and were more satisfied with the decision-making process, without increased distress or regret related to the decisions they made.

‘Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation,’ the review authors wrote.

‘When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer.’

Professor Tammy Hoffmann, Professor of Clinical Epidemiology at the Institute for Evidence-Based Healthcare, Bond University, Gold Coast, said decision aids improved patients’ active involvement in and satisfaction with the decision-making process and improved the accuracy of their risk perception.

‘This is important for making informed decisions, as we know that most patients overestimate intervention benefits and underestimate their harms,’ she told Medicine Today.

The findings from the updated review were similar to the previous version, she noted, but the large increase in the number of included studies meant the quality of the evidence was rated higher for many of the outcomes and there was greater certainty in the results.

Professor Hoffmann, who leads the Centre for Evidence-Informed Health Decisions at Bond University, said research had shown decision aid use was quite low in Australia, with many missed opportunities for collaboratively involving patients in decisions about their care.

She added that some practitioners were reluctant to use decision aids as they feared they would greatly increase the length of a consultation, but this review had shown that was not the case.

‘We now have plenty of evidence that patient decision aids, when used, can improve many outcomes. What now needs attention, from researchers and policymakers, is how to increase their use,’ she said.

‘One initiative which has shown some promise in making decision aids more accessible to clinicians is embedding them within clinical practice guidelines and other point-of-care resources.’

Cochrane Database Syst Rev 2024; (1): CD001431.