Review question

How effective/beneficial are patient decision aids for adults making decisions regarding health treatment or screening?

Key messages

- Patient decision aids are pamphlets or videos used in person or online. They clearly identify the healthcare decision to be made, provide information on options (benefits and harms), and help people clarify what is most important to them. Decision aids are designed to enhance and supplement consultation with the clinician, not replace it.

- Over 200 studies showed that patient decision aids helped adults be more involved in making health decisions by improving their knowledge and expectations of benefits and harms, and choosing an option that reflected what was most important to them.

- There were no unwanted effects for adults who used a patient decision aid.

What are patient decision aids?

Patient decision aids can help guide people making decisions when there is more than one option, including status quo (no change). They are pamphlets, videos, or web-based resources that state the decision, describe the options, and help people think about which features of the options are most important to them (which features matter most). Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention.

What did we want to find out?

We wanted to find out if patient decision aids used by patients who are facing health treatment or screening decisions are better than the usual care for choosing an option that reflects what is most important to them. We also wanted to find out if patient decision aids were associated with any unwanted effects.

What did we do?

We updated a previous Cochrane review that was first published in 2003 and then updated in 2017. Our search included studies that compared a patient decision aid with usual care in adults who were facing health decisions for themselves or a family member. Usual care may have been general patient information or nothing. We compared and summarized the results of the studies and rated our confidence in the certainty of the evidence.

What did we find?

We found 209 studies that involved 107,698 adults. The patient decision aids focused on 71 different decisions. The common decisions were about: surgery, screening (e.g. prostate cancer, colon cancer, prenatal), genetic testing, and long-term medication treatments (e.g. insulin injections for diabetes, or statins for high cholesterol).

We are moderately confident that adults given patient decision aids were more likely to choose an option that reflected what features of the options were most important to them. Our confidence in the evidence is only moderate because the studies that provided results for our review represent only a small set of the studies evaluating patient decision aids. We are confident that when adults used patient decision aids, they had large increases in their knowledge, expectations of benefits and harms, and participation in making the decision. We are also confident that they felt better informed and were more clear about what mattered most to them. We are confident that patient decision aids did not cause any unwanted effects such as regret about the decision.

What are the limitations of the evidence?

Further research could strengthen the confidence in the evidence for choosing options that reflect which features of the options are most important to people.

How up-to-date is this evidence?

This review updates our previous review published in 2017. The evidence is up-to-date to March 2022.