Abstract
BackgroundThere is evidence to suggest that decision aids improve a number of patient outcomes. However, little is known about the progression of research effort in this area over time. This literature review examined the volume of research published in 2000, 2007 and 2014 which tested the effectiveness of decision aids in improving cancer patient outcomes, coded by cancer site and decision type being targeted. These numbers were compared with the volume of research examining the effectiveness of strategies to increase the adoption of decision aids by healthcare providers.MethodsA literature review of intervention studies was undertaken. Medline, Embase, PsychInfo and Cochrane Database of Systematic Reviews were searched. The search was limited to human studies published in English, French, or German. s were assessed against eligibility criteria by one reviewer and a random sample of 20 % checked by a second. Eligible intervention studies in the three time periods were categorised by: i) whether they tested the effectiveness of decision aids, coded by cancer site and decision type, and ii) whether they tested strategies to increase healthcare provider adoption of decision aids.ResultsOver the three time points assessed, increasing research effort has been directed towards testing the effectiveness of decision aids in improving patient outcomes (p < 0.0001). The number of studies on decision aids for cancer screening or prevention increased statistically significantly (p < 0.0001) whereas the number of studies on cancer treatment did not (p = 1.00). The majority of studies examined the effectiveness of decision aids for prostate (n = 10), breast (n = 9) or colon cancer (n = 7). Only two studies assessed the effectiveness of implementation strategies to increase healthcare provider adoption of decision aids.ConclusionsWhile the number of studies testing the effectiveness of decision aids has increased, the majority of research has focused on screening and prevention decision aids for only a few cancer sites. This neglects a number of cancer populations, as well as other areas of cancer care such as treatment decisions. Also, given the apparent effectiveness of decision aids, more effort needs to be made to implement this evidence into meaningful benefits for patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0273-8) contains supplementary material, which is available to authorized users.
Highlights
There is evidence to suggest that decision aids improve a number of patient outcomes
Across the three time points assessed, the number of studies focusing on cancer screening and prevention decision aids increased significantly (p < 0.0001), while the number focused on cancer treatment did not (p = 1.00, Fig. 2)
Research priorities by relative volume of intervention studies We examined the progression of research volume which tested the effectiveness of decision aids by cancer site and decision type being targeted, across three time points
Summary
There is evidence to suggest that decision aids improve a number of patient outcomes. Clinical decision making is largely viewed as a collaborative process in which the clinician, the patient (and their support persons) choose healthcare options together, based on the patient’s informed preferences [5, 6] Involving patients in their healthcare decisions is associated with improved patient outcomes, including decreases in patient unmet information needs and anxiety and increases in patients’ satisfaction with the consultation [7, 8]. Preference-sensitive healthcare decisions are challenging Patients’ willingness to become involved in decisions may be hampered by difficulties in choosing between the various healthcare options available to them [13, 14] This is especially true for “preference-sensitive” decisions, where there is little or no difference in the medical effectiveness of the available healthcare options. Each of these treatments shows similar medical effectiveness for these patients but holds various side effects and impacts that may be valued differently by different patients [17]
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