RT Journal Article
SR Electronic
T1 Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 499
OP 510
DO 10.1136/bmjqs-2018-008022
VO 28
IS 6
A1 Claudia Caroline Dobler
A1 Manuel Sanchez
A1 Michael R Gionfriddo
A1 Neri A Alvarez-Villalobos
A1 Naykky Singh Ospina
A1 Gabriela Spencer-Bonilla
A1 Bjorg Thorsteinsdottir
A1 Raed Benkhadra
A1 Patricia J Erwin
A1 Colin P West
A1 Juan P Brito
A1 Mohammad Hassan Murad
A1 Victor M Montori
YR 2019
UL http://qualitysafety.bmj.com/content/28/6/499.abstract
AB 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.