Design and Testing of Tools for Shared Decision Making

Abstract

Shared decision making (SDM) is grounded in a compelling theoretical framework that ideally helps patients make decisions that are informed and concordant with their goals and values.1,2 Yet operationalizing SDM within routine clinical care remains an important challenge. Several approaches have been studied to improve SDM; such strategies include educating clinicians on communication techniques, using a multidisciplinary medical team, incorporating trained decision coaches, and using tools to support patients in their decision making. These tools, commonly referred to as patient decision aids (PtDAs), have garnered the most interest in operationalizing SDM.3 Accordingly, this article will focus specifically on the development and testing of PtDAs highlighting some important key points (see Box). ### Key Points of the Article on Decision Tool Development 1. PtDAs should be used in conjunction with a conversation with a clinician. 2. Helping patients consider and clarify their values around a decision is what makes a PtDA different from an information pamphlet. 3. Development is iterative, and the key tasks are to make sure the information is understandable, accurate, and unbiased and that the tool fits the needs and workflow of the end-users. 4. Trials designed to test the effectiveness of a decision aid need to consider both the patient’s and the clinician’s experience with the tool. 5. Decision aids should be living documents that will require updating when new information arises. Extensive work has been undertaken by the International Patient Decision Aid Standards (IPDAS) collaboration to provide guidance in this arena. Founded in 2003, IPDAS aims to “enhance the quality and effectiveness of PtDAs by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation.”4,5 This article will draw on the extensive work of the IPDAS collaboration to describe a 4-step development process for those interested in developing PtDAs, which includes, step 1: understanding the decision; step 2: drafting the first …