for the main comparison.
| Patient decision aids compared with usual care for adults considering treatment or screening decisions | ||||||
|
Patient or population: adults considering treatment or screening decisions Settings: all settings Intervention: patient decision aid Comparison: usual care | ||||||
| Outcomes | Illustrative comparative benefits* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed benefit | Corresponding benefit | |||||
| Usual care | Patient decision aid | |||||
|
Knowledge ‐ all studies Standardized on score from 0 (no knowledge) to 100 (perfect knowledge), soon after exposure to the decision aid |
The mean knowledge score was 56.9% across control groups, ranging from 27.0% to 85.2% | The mean knowledge score in the intervention groups was 13.27 higher (11.32 to 15.23 higher) | — | 13,316 (52 studies) | ⊕⊕⊕⊕ Higha,b | Higher scores indicate better knowledge. 46 out of 52 studies showed a statistically significant improvement in knowledge |
|
Accurate risk perceptions ‐ all studies Assessed soon after exposure to the decision aid |
269 per 1000c | 565 per 1000 (447 to 716 per 1000) | RR 2.10 (1.66 to 2.66) | 5096 (17 studies) | ⊕⊕⊕⊝ Moderatea,d | — |
|
Congruence between the chosen option and informed values ‐ all studies Assessed soon after exposure to the decision aid |
289 per 1000c | 595 per 1000 (422 to 841 per 1000) | RR 2.06 (1.46 to 2.91) | 4626 (10 studies) |
⊕⊕⊝⊝ Lowa,d,e,f | — |
|
Decisional conflict: uninformed subscale ‐ all studies Standardized on score from 0 (not uninformed) to 100 (uninformed) Assessed soon after exposure to the decision aid |
The mean for outcome 'feeling uninformed' ranged across control groups from 11.1 to 61.1. Scores ≤ 25 associated with following through on decisions. Scores > 38 associated with delay in decision making |
The mean feeling uninformed in the intervention groups was 9.28 lower (12.20 to 6.36 lower) | — | 5707 (27 studies) |
⊕⊕⊕⊕ Higha,b | Lower scores indicate feeling more informed |
|
Decisional conflict: unclear about personal values subscale ‐ all studies Standardized on score from 0 (not unclear) to 100 (unclear) Assessed soon after exposure to the decision aid |
The mean for outcome 'feeling unclear about personal values' ranged across control groups from 15.5 to 53.2. Scores ≤ 25 associated with follow‐through with decisions. Scores > 38 associated with delay in decision making |
The mean feeling unclear values in the intervention groups was 8.81 lower (11.99 to 5.63 lower) | — | 5068 (23 studies) |
⊕⊕⊕⊕ Higha,b | Lower scores indicate feeling clearer about values |
|
Participation in decision making: clinician‐controlled decision making ‐ all studies Assessed soon after consultation with clinician |
228 per 1000c | 155 per 1000 (125 to 189 per 1000) | RR 0.68 (0.55 to 0.83) | 3180 (16 studies) | ⊕⊕⊕⊝ Moderatea,e | Patient decision aids aim to increase patient involvement in making decisions; lower proportion of clinician‐controlled decision making is better |
| Adverse events | There were no adverse effects on health outcomes or satisfaction, and no other adverse effects reported. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aThe vast majority of studies measuring this outcome were not at high risk of bias. bThe GRADE ratings for these outcomes were not downgraded for heterogeneity given the generally consistent direction of effects across studies for the decision aid compared to usual care groups. cThe data source for the assumed risk was the mean control event rate. dThe GRADE rating was downgraded given the lack of precision. eThe GRADE rating was downgraded given the lack of consistency. fThe GRADE rating was downgraded given the lack of directness. As well, the outcome was measured using various approaches with no gold standard approach.