Do personal stories make patient decision aids more effective? A critical review of theory and evidence

Hilary L Bekker,Anna E Winterbottom,Amanda J Dillard,Victoria A Shaffer,Phyllis Butow,Floyd J Fowler,Robert J Volk,Deb Feldman-Stewart,Maria L Jibaja-Weiss

doi:10.1186/1472-6947-13-s2-s9

Abstract

BackgroundPatient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions.MethodsA survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings.ResultsOf 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies.ConclusionsThere is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources.

Highlights

Patient decision aids support people to make informed decisions between healthcare options
PtDAs are complex interventions with components designed to a) provide evidence-based information presented in a way that enhances patient understanding of the health problem, treatment options and their consequences, b) structure and categorise information enabling people to attend to more details with less cognitive effort and/or bias, and c) guide people in the process of reaching a decision by making explicit their values and/or trade-offs between evaluations
Search strategy We searched for all articles with a decision making term and a personal story term

Summary

Introduction

Patient decision aids support people to make informed decisions between healthcare options. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in nonnarrative prose It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. PtDAs are complex interventions with components designed to a) provide evidence-based information presented in a way that enhances patient understanding of the health problem, treatment options and their consequences, b) structure and categorise information enabling people to attend to more details with less cognitive effort and/or bias, and c) guide people in the process of reaching a decision by making explicit their values and/or trade-offs between evaluations. PtDAs are evaluated more broadly to assess their impact on aspects of the real-world health context, such as patients’ engagement with health information and service resources, patient-professional interactions, and shared decision making [1,2,3]

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