Patient Decision Aids

What Are Patient Decision Aids?

According to the International Patient Decision Aids Standards Collaboration, PtDAs are tools to help patients participate in their healthcare decisions in the ways they prefer. They supplement rather than replace a practitioner's counseling. PtDAs provide facts about options and outcomes, communicate probabilities of benefits and harms, clarify which benefits and harms matter the most, and guide patients in the steps of deliberation and communication.

PtDA development has been guided by several different decision theory and transactional frameworks from economics, psychology, and sociology. The mode of delivering PtDAs varies (print, audio-booklet, videotape, DVD, and, more recently, interactive multimedia Web-based tools). PtDAs are self-administered or practitioner administered; they are used in one-to-one or group situations; and they are used before, during, or after the clinical encounter.

Regardless of the framework, medium, or implementation strategy, there are three key elements common to their design:

1. Information provision: For a given clinical condition, PtDAs include high-quality, up-to-date information about the condition or disease stimulating the need for a decision, the available healthcare options, the likely outcomes for each option, the probabilities associated with those outcomes, and the level of scientific uncertainty. The information is clearly presented as a “choice situation,” in a balanced manner so as not to persuade the viewer toward any particular option and in sufficient detail to permit choosing among the options.

2. Values clarification: A range of methods may be used to help patients consider the personal value or desirability/undesirability of options. First, patients are better able to judge the value of options when they are familiar and easy to imagine. Therefore, PtDAs describe what it is like to experience the physical, emotional, and social consequences of the procedures involved and the potential benefits and harms. Second, patients are asked to consider (either implicitly or explicitly) the positive and negative features that matter most to them. Although there is no clinical trial evidence that explicit methods are always needed, some developers directly engage patients in rating the personal value or importance of each attribute of the options. They argue that these exercises foster engagement, insight, and communication with the others involved. Other developers argue that implicit methods work just as well and are simpler. Moreover, decision scientists have demonstrated in nonmedical contexts that people are not good at predicting the intensity and duration of their feelings regarding future losses or gains. As has been demonstrated in the case of choosing household goods (jam, posters), people may also be more dissatisfied with their choices if they explicitly consider each individual attribute of options rather than make an overall holistic judgment. This debate should be resolved in clinical trials involving practitioners and patients facing real medical decisions.

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