Table 3.

RCTs of Decision Tools for Current Treatment

Source	Study Population	Intervention and Control	Evidence of Effect on Patient-Centered Outcomes	Rating and Accessibility of the Tool^a
Clayton et aI,⁴⁶ 2007	174 Australian outpatients with advanced cancer Severity of illness: moderate to severe	Intervention: 16-page booklet “Asking Questions Can Help: An Aid for People Seeing the Palliative Care Team” with 112 questions on end-of-life care that can be discussed with a physician Control: usual care	Moderate impact Patients in intervention group asked 2.31 times more questions (95% CI, 1.68–3.18; P < .001) of clinicians, discussed more items (17.6 vs 12.7; P = .002), and spent more time per visit (37.8 vs 30.5 min) No change in anxiety or information need at 3 wk	GRADE A Free online (http://www.psych.usyd.edu.au/cemped/docs/comms_Bookletl.pdf)
El-Jawahri et al,⁴¹ 2010	50 Outpatients with malignant glioma Severity of illness: moderate	Intervention: narrative about choice of 3 levels of medical care followed by a 6-min video depicting elements of life-prolonging, limited care and comfort focus Control: narrative descriptions only	Lesser impact Increased choice for comfort care (91% vs 22%; P < .0001)	GRADE A Clinicians may purchase online (http://www.acpdecisions.org/)
Epstein et al,³⁹ 2013	56 Ambulatory outpatients with progressive pancreatic or hepatobiliary cancer Severity of illness: severe	Intervention: 3-min video on CPR and MV Control: narrative description of CPR and MV	Lesser impact No change in CPR or ventilator preferences Trend in ACP documentation at 1 mo (40% vs 15%; P = .07) No change in CPR or MV knowledge	GRADEB Clinicians may purchase online (http://www.acpdecisions.org/)
Hanson et al,⁴⁰ 2011	256 Patients in nursing homes aged ≥65 y with advanced dementia Severity of illness: severe	Intervention: audio or printed information on dementia and feeding options Control: usual care	Moderate impact Decreased decisional conflict at 3 mo (DCS score, 1.65 vs 1.97; P < .001) Increased frequency of communication with health care practitioners at 3 mo (46%vs 33%; P= .04) Increase in use of dysphagia diet at 3 mo (89% vs 76%; P = .04)	GRADE A Free online (http://www.med.unc.edu/pcare/resources/feedingoptions)
Leighl et al,³⁸ 2011	207 Outpatients with metastatic colorectal cancer in Canada and Australia Severity of illness: moderate to severe	Intervention: booklet with video that reviews goals of palliative treatment with and without chemotherapy Control: usual care	Lesser impact No change in choice to undergo chemotherapy at 1 to 2 wk No change in decisional conflict or satisfaction Greater increase in knowledge (16% vs 5% increase; P < .001)	GRADE A Not available
Meropol et al,⁴⁸ 2013	743 Outpatients with known metastatic solid tumors Severity of illness: moderate to severe	Intervention: communication skills training in a 15-min online module that addressed how to prepare for an initial oncology visit and what questions to ask Control: link to the National Cancer Institute website	Lesser impact Increase in overall satisfaction with communication at 3 mo Increase in ease of decision making (P < .01) and with actual decision (P< .001) No change in decisional conflict	GRADEB Not available
Peele et al,⁴⁷ 2005	432 Outpatients with breast cancer s/p surgery and eligible for adjuvant therapy Severity of illness: moderate	Intervention: online tool estimating prognosis with and without adjuvant therapy Control: general informational pamphlet	Moderate impact Decreased choice of adjuvant therapy (P < .05)	GRADEB Not available
Stirling et al,⁴⁹ 2012	31 Community-dwelling caregivers of patients with dementia in Australia Severity of illness: moderate	Intervention: workbook with information about community services for the elderly, respite care, and trajectory of decline in dementia Control: usual care	No impact No change in decisional conflict, knowledge, or treatment preferences	GRADEB Not available
Vandemheen et al,⁵⁰ 2009	151 Outpatients in Canada and United States with CF with FEV₁ < 40% predicted Severity of illness: severe	Intervention: print and online aid on CF and lung transplant Control: usual care	Lesser impact Improved knowledge (P < .001) and realistic expectations (P < .001) Reduced decisional conflict (DCS score, 11.6 vs 20.4; P = .0007) No change in transplant choice at 12 mo	GRADE A Free online (http://decisionaid.ohri.ca/docs/das/CF_Australia.pdf)
Volandes et al,⁴² 2012	101 Patients aged ≥ 65 years newly admitted to skilled nursing facilities in Boston area Severity of illness: moderate	Intervention: narrative about 3 levels of medical care (life prolonging, limited care, and comfort focus) followed by a 6-min video depicting these Control: narrative descriptions only	Lesser impact Increased choice for comfort care (80% vs 57% stated they would choose comfort measures; P = .02)	GRADE A Clinicians may purchase online (http://www.acpdecisions.org/)
Yun et al,⁵¹ 2011	444 Caregivers of terminally ill patients with cancer in Korea Severity of illness: severe	Intervention: video “Patients Want to Know the Truth” with booklet discussing disclosure of terminal status to patients and intrafamily communication Control: National Cancer Institute video and booklet on cancer pain management	Lesser impact No change in decision to discuss terminal prognosis Decrease in decisional conflict initially (P = .008) and at 6 mo (P = .031) Decreased caregiver depression initially (P = .007) and at 6 mo (P = .008)	GRADE A Not available

Abbreviations: ACP, advance care planning; CF, cystic fibrosis; CPR, cardiopulmonary resuscitation; DCS, Decisional Conflict Scale; FEV,, forced expiratory volume in the first second of expiration; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; MV, manual ventilation; RCT, randomized clinical trial; s/p, status post.

GRADE ratings are explained in the Data Synthesis and Analysis subsection of the Methods section.