Cargando…

Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review

BACKGROUND: Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decis...

Descripción completa

Detalles Bibliográficos
Autores principales: Staszewska, Anna, Zaki, Pearl, Lee, Joon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650682/
https://www.ncbi.nlm.nih.gov/pubmed/28986341
http://dx.doi.org/10.2196/medinform.6405
_version_ 1783272749232291840
author Staszewska, Anna
Zaki, Pearl
Lee, Joon
author_facet Staszewska, Anna
Zaki, Pearl
Lee, Joon
author_sort Staszewska, Anna
collection PubMed
description BACKGROUND: Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. OBJECTIVE: The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. METHODS: PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. RESULTS: Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. CONCLUSIONS: Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness.
format Online
Article
Text
id pubmed-5650682
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher JMIR Publications
record_format MEDLINE/PubMed
spelling pubmed-56506822017-10-26 Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review Staszewska, Anna Zaki, Pearl Lee, Joon JMIR Med Inform Original Paper BACKGROUND: Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. OBJECTIVE: The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. METHODS: PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. RESULTS: Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. CONCLUSIONS: Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness. JMIR Publications 2017-10-06 /pmc/articles/PMC5650682/ /pubmed/28986341 http://dx.doi.org/10.2196/medinform.6405 Text en ©Anna Staszewska, Pearl Zaki, Joon Lee. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 06.10.2017. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Staszewska, Anna
Zaki, Pearl
Lee, Joon
Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title_full Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title_fullStr Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title_full_unstemmed Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title_short Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review
title_sort computerized decision aids for shared decision making in serious illness: systematic review
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650682/
https://www.ncbi.nlm.nih.gov/pubmed/28986341
http://dx.doi.org/10.2196/medinform.6405
work_keys_str_mv AT staszewskaanna computerizeddecisionaidsforshareddecisionmakinginseriousillnesssystematicreview
AT zakipearl computerizeddecisionaidsforshareddecisionmakinginseriousillnesssystematicreview
AT leejoon computerizeddecisionaidsforshareddecisionmakinginseriousillnesssystematicreview