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  • Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

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Systematic review
Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review
  1. Claudia Caroline Dobler1,2,
  2. Manuel Sanchez2,
  3. Michael R Gionfriddo3,
  4. Neri A Alvarez-Villalobos2,4,
  5. Naykky Singh Ospina2,5,
  6. Gabriela Spencer-Bonilla2,
  7. Bjorg Thorsteinsdottir1,6,
  8. Raed Benkhadra1,
  9. Patricia J Erwin7,
  10. Colin P West8,9,
  11. Juan P Brito2,
  12. Mohammad Hassan Murad1,
  13. Victor M Montori2
  1. 1 Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, Pennsylvania, USA
  4. 4 Facultad de Medicina y Hospital Universitario, Unidad de Investigación Clínica, Universidad Autonoma de Nuevo León, Monterrey, Mexico
  5. 5 Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
  6. 6 Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  7. 7 Medical Library, Mayo Clinic, Rochester, Minnesota, USA
  8. 8 Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  9. 9 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Claudia Caroline Dobler, Mayo Clinic, Evidence-Based Practice Center, Rochester, MN 55905, USA; dobler.claudia{at}mayo.edu

Abstract

Background Clinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes.

Methods We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach.

Results Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors.

Conclusion Decision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.

  • health services research
  • shared decision making
  • communication

https://doi.org/10.1136/bmjqs-2018-008022

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    Footnotes

    • Contributors CCD, MRG, CPW, GS-B, JPB and VMM developed the study protocol. PJE performed the literature search. CCD, MS, MRG, NAA-V, NSO, GS-B, BT, RB and VMM reviewed studies for inclusion and/or performed data extraction. MHM helped with data analysis. CCD drafted the manuscript. All authors reviewed and contributed to versions of the manuscript and approved the final submission.

    • Funding CCD was supported by a fellowship of the National Health and Medical Research Council (APP1123733). BT was supported by a National Institute on Aging grant K23AG051679 and the Norman S. Coplon Extramural Grant Program of Satellite Healthcare, a not-for-profit renal care provider.

    • Disclaimer The sponsors had no role in manuscript design, data interpretation or writing of the manuscript.

    • Competing interests MRG has conducted consulting work around shared decision making for Pfizer with travel costs and honoraria paid to his institution. MRG was also paid by Hillcrest Medical Center (Tulsa, OK) to speak on SDM at a continuing medical education event with travel costs and an honorarium paid to his institution; no other relationships or activities that could appear to have influenced the submitted work.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.