Decision Coaching Research Articles

Role of allied health care professionals in goals-of-care discussions with hospitalized patients and perceived barriers: a cross-sectional survey.

Allied health care professionals can contribute meaningfully to goals-of-care discussions with seriously ill hospitalized patients and their families. We sought to explore the perspective of hospital-based allied health care professionals on their role in goals-of-care discussions and to identify barriers to their participation. We surveyed allied health care professionals (social workers, physiotherapists, occupational therapists, registered dietitians, speech-language pathologists and pharmacists) on internal medicine, hematology-oncology, medical oncology and radiation oncology wards at 2 tertiary care hospitals in Hamilton, Ontario, from April 2013 to May 2014. We modified a validated questionnaire originally designed to assess barriers to discussing goals of care from the perspective of nurses, residents and staff physicians on hospital medical wards. Respondents rated the questionnaire items on a 7-point Likert scale. Of the 47 allied health care professionals invited, 32 (68%) participated: 9 physiotherapists, 7 social workers, 6 occupational therapists, 4 registered dietitians, 3 pharmacists and 2 speech-language pathologists; in 1 case, the profession was unknown. The greatest perceived barriers to engaging in goals-of-care discussions were lack of patient decision-making capacity (mean rating 5.9 [standard error (SE) 0.3]), lack of awareness of patients' previous discussions with other team members (mean rating 5.7 [SE 0.3]) and family members' difficulty accepting a poor prognosis (mean rating 5.6 [SE 0.2]). Although the respondents felt it was most acceptable for staff physicians, residents and advanced practice nurses to exchange information and reach a final decision during goals-of-care discussions, they felt it was acceptable for a broader range of allied health care professionals to initiate discussions (mean rating 4.7-5.8) and to act as decision coaches (clarifying values, weighing options) with patients and families (mean rating 5.3-6.1). Allied health care professionals are willing to initiate goals-of-care discussions and to act as a decision coach with seriously ill hospitalized patients and their families. By improving interprofessional collaboration, we can engage the entire health care team in this process.

Coaching to support men in making informed choices about prostate cancer screening: A qualitative study

ObjectiveThe objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. MethodsSeven focus groups were conducted with 47 participants, representing three stakeholder groups − men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis. ResultsKnowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation. ConclusionGPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice. Practice implicationsA feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation

BackgroundTreatment decision-making is complex for people with multiple sclerosis. Profound information on available options is virtually not possible in regular neurologist encounters. The “nurse decision coach model” was developed to redistribute health professionals’ tasks in supporting immunotreatment decision-making following the principles of informed shared decision-making. ObjectivesTo test the feasibility of a decision coaching programme and recruitment strategies to inform the main trial. DesignFeasibility testing and parallel pilot randomised controlled trial, accompanied by a mixed methods process evaluation. SettingTwo German multiple sclerosis university centres. Participants pilot trialPeople with suspected or relapsing-remitting multiple sclerosis facing immunotreatment decisions on first line drugs were recruited. Randomisation to the intervention (n = 38) or control group (n = 35) was performed on a daily basis. Quantitative and qualitative process data were collected from people with multiple sclerosis, nurses and physicians. MethodsWe report on the development and piloting of the decision coaching programme. It comprises a training course for multiple sclerosis nurses and the coaching intervention. The intervention consists of up to three structured nurse-led decision coaching sessions, access to an evidence-based online information platform (DECIMS-Wiki) and a final physician consultation. After feasibility testing, a pilot randomised controlled trial was performed. People with multiple sclerosis were randomised to the intervention or control group. The latter had also access to the DECIMS-Wiki, but received otherwise care as usual. Nurses were not blinded to group assignment, while people with multiple sclerosis and physicians were. The primary outcome was ‘informed choice’ after six months including the sub-dimensions’ risk knowledge (after 14 days), attitude concerning immunotreatment (after physician consultation), and treatment uptake (after six months). Quantitative process evaluation data were collected via questionnaires. Qualitative interviews were performed with all nurses and a convenience sample of nine people with multiple sclerosis. Results116 people with multiple sclerosis fulfilled the inclusion criteria and 73 (63%) were included. Groups were comparable at baseline. Data of 51 people with multiple sclerosis (70%) were available for the primary endpoint. In the intervention group 15 of 31 (48%) people with multiple sclerosis achieved an informed choice after six months and 6 of 20 (30%) in the control group. Process evaluation data illustrated a positive response towards the coaching programme as well as good acceptance. ConclusionsThe pilot-phase showed promising results concerning acceptability and feasibility of the intervention, which was well perceived by people with multiple sclerosis, most nurses and physicians. Delegating parts of the immunotreatment decision-making process to trained nurses has the potential to increase informed choice and participation as well as effectiveness of patient-physician consultations.

Field testing of decision coaching with a decision aid for parents facing extreme prematurity

The objective of this study is to assess and modify an existing decision aid and field-test decision coaching with the modified aid during consultations with parents facing potential delivery at 23 to 24 weeks gestation. International Patient Decision Aid Standards instrument (IPDASi) scoring deficits, multi-stakeholder group feedback and α-testing guided modifications. Feasibility/acceptability were assessed. The Decisional Conflict Scale was used to measure participants' decisional conflict before (T1) and immediately after (T2) the consultation. IPDASi assessment of the existing aid (score 11/35) indicated it required updated data, more information and a palliative care description. Following modification, IPDASi score increased to 26/35. Twenty subjects (12 pregnancies) participated in field-testing; 15 completed all questionnaires. Most participants (89%) would definitely recommend this form of consultation. Decisional conflict scores decreased (P<0.001) between T1 (52±25) and T2 (10±16). Field testing demonstrated that consultations using the aid with decision coaching were feasible, reduced decisional conflict and may facilitate shared decision-making.

Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes

ObjectiveEvaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group. MethodsAdults with type 2 diabetes (n=54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule. ResultsThere was a significant difference between groups for diabetes empowerment (p=0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p≤0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p≤0.05). ConclusionsSetting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management. Practice implicationsInformed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals’ lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress.

Decision Support for a Woman Considering Continuing Extended Endocrine Therapy for Breast Cancer: A Case Study

This case study evaluated decision coaching with a breast cancer survivor considering continuing extended endocrine therapy from eight years to 10 years. The survivor, aged 58 years and who completed surgery and chemotherapy eight years ago, was concerned about side effects of endocrine therapy. Decision coaching based on the Ottawa Decision Support Framework involved an oncology nurse using the Ottawa Personal Decision Guide. Compared to baseline (2 out of 4), decisional comfort improved (3 out of 4) post decision coaching. The survivor felt more certain, but wanted further advice from her oncologist. She was leaning toward discontinuing endocrine therapy given she valued quality of life over a small risk of recurrence. Audio-recording analysis using the Decision Support Analysis Tool revealed high decision coaching quality (10/10). Breast cancer survivors facing preference-sensitive decisions about extended endocrine therapy could be supported with decision coaching by oncology nurses to ensure informed values-based decisions.

Shared Decision Making (SDM) in Pediatric Type 1 Diabetes: Evaluation of Decision Coaching with a Patient Decision Aid

Purpose: To evaluate the effect of decision coaching with a decision aid on decisional conflict and participants' satisfaction for youth and parents considering a change in insulin delivery method.

A new engineering profession is emerging: decision coach

More than half of the decisions faced by corporate executives deal with expansion or investment in new and existing products, services, or geographies. These decisions are complicated technically and organizationally. As a result, the decisions tend to be made by teams from multiple functions: research, engineering, marketing, sales, manufacturing, public relations, and legal. Strategic decision making has become a team sport. Teams need coaches to help pick the right processes; apply the right tools; facilitate learning; and manage projects. This article is about an emerging profession: decision coach. The article explains why most decision coaches will probably begin their coaching careers as decision engineers.

Leadership

PLEASE note that this issue includes four original articles: An Engineering Profession is Emerging: Decision Coach, by Stephen. M. Barrager, PhD and IEEE Member; Assessing Cultural Influences in Megaproject Practices, by F. Pau, A. Langland, and O. Nja; Telemedicine: Determining Critical Quality Characteristics for a Healthcare Service System, by Sameer Kumar, Peter Southard, and Matthew White; and Big Data Commercialization, by Llewellyn D. W. Thomas, and Aija Leiponen.

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

BackgroundWomen with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices.In this trial, the informed shared decision-making program will be evaluated in breast care centers.Methods/DesignA cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited.Primary outcome is the extent of patients’ involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the ‘sharing’ in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters.It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients’ involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted.DiscussionTo our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers.Trial registrationCurrent Controlled Trials ISRCTN46305518, date of registration: 5 June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0991-8) contains supplementary material, which is available to authorized users.

80: Modification &amp; Field Testing of a Decision Aid &amp; Decision Coaching for Counseling Parents Facing the Potential Birth of an Extremely Premature Infant

80: Modification &amp; Field Testing of a Decision Aid &amp; Decision Coaching for Counseling Parents Facing the Potential Birth of an Extremely Premature Infant

공동의사결정에서 의사결정 코칭(Decision Coaching)의 함의*

In shared decision-making, patients and physicians work together as decision-making partners. To overcome the imbalance of medical knowledge between physicians and patients and to assist patients in the shared decision-making process, patient decision aids (PtDAs) have been proposed. PtDAs improve patients’ knowledge, enhance their accurate perception of risks, help them achieve choices that match their values, and stimulate them to become more actively involved in the decision-making process. Nevertheless, many studies have reported that patients have difficulty in fully participating in shared-decision making. This in turn gives rise to the need for medical decision coaching, which aims to develop patients' confidence and skills in deliberating about options and helps to prepare them for making decisions with their practitioners. Medical decision coaching is provided by trained individuals, and the coach’s role has been described as that of a medical decision counsellor, educator, navigator, and facilitator. In this article, I describe a framework for medical decision coaching to support shared decisions. Additionally I discuss the implications of medical decision coaching in Korean society.

Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians.

Seriously ill hospitalized patients have identified communication and decision making about goals of care as high priorities for quality improvement in end-of-life care. Interventions to improve care are more likely to succeed if tailored to existing barriers. To determine, from the perspective of hospital-based clinicians, (1) barriers impeding communication and decision making about goals of care with seriously ill hospitalized patients and their families and (2) their own willingness and the acceptability for other clinicians to engage in this process. Multicenter survey of medical teaching units of nurses, internal medicine residents, and staff physicians from participating units at 13 university-based hospitals from 5 Canadian provinces. Importance of 21 barriers to goals of care discussions rated on a 7-point scale (1 = extremely unimportant; 7 = extremely important). Between September 2012 and March 2013, questionnaires were returned by 1256 of 1617 eligible clinicians, for an overall response rate of 77.7% (512 of 646 nurses [79.3%], 484 of 634 residents [76.3%], 260 of 337 staff physicians [77.2%]). The following family member-related and patient-related factors were consistently identified by all 3 clinician groups as the most important barriers to goals of care discussions: family members' or patients' difficulty accepting a poor prognosis (mean [SD] score, 5.8 [1.2] and 5.6 [1.3], respectively), family members' or patients' difficulty understanding the limitations and complications of life-sustaining treatments (5.8 [1.2] for both groups), disagreement among family members about goals of care (5.8 [1.2]), and patients' incapacity to make goals of care decisions (5.6 [1.2]). Clinicians perceived their own skills and system factors as less important barriers. Participants viewed it as acceptable for all clinician groups to engage in goals of care discussions-including a role for advance practice nurses, nurses, and social workers to initiate goals of care discussions and be a decision coach. Hospital-based clinicians perceive family member-related and patient-related factors as the most important barriers to goals of care discussions. All health care professionals were viewed as playing important roles in addressing goals of care. These findings can inform the design of future interventions to improve communication and decision making about goals of care.

Evaluator-blinded trial evaluating nurse-led immunotherapy DEcision Coaching In persons with relapsing-remitting Multiple Sclerosis (DECIMS) and accompanying process evaluation: study protocol for a cluster randomised controlled trial

BackgroundMultiple sclerosis is a chronic neurological condition usually starting in early adulthood and regularly leading to severe disability. Immunotherapy options are growing in number and complexity, while costs of treatments are high and adherence rates remain low. Therefore, treatment decision-making has become more complex for patients. Structured decision coaching, based on the principles of evidence-based patient information and shared decision-making, has the potential to facilitate participation of individuals in the decision-making process.This cluster randomised controlled trial follows the assumption that decision coaching by trained nurses, using evidence-based patient information and preference elicitation, will facilitate informed choices and induce higher decision quality, as well as better decisional adherence.Methods/DesignThe decision coaching programme will be evaluated through an evaluator-blinded superiority cluster randomised controlled trial, including 300 patients with suspected or definite relapsing-remitting multiple sclerosis, facing an immunotherapy decision. The clusters are 12 multiple sclerosis outpatient clinics in Germany. Further, the trial will be accompanied by a mixed-methods process evaluation and a cost-effectiveness study.Nurses in the intervention group will be trained in shared decision-making, coaching, and evidence-based patient information principles. Patients who meet the inclusion criteria will receive decision coaching (intervention group) with up to three face-to-face coaching sessions with a trained nurse (decision coach) or counselling as usual (control group). Patients in both groups will be given access to an evidence-based online information tool.The primary outcome is ‘informed choice’ after six months, assessed with the multi-dimensional measure of informed choice including the sub-dimensions risk knowledge (questionnaire), attitude concerning immunotherapy (questionnaire), and immunotherapy uptake (telephone survey). Secondary outcomes include decisional conflict, adherence to immunotherapy decisions, autonomy preference, planned behaviour, coping self-efficacy, and perceived involvement in coaching and decisional encounters. Safety outcomes are comprised of anxiety and depression and disease-specific quality of life.DiscussionThis trial will assess the effectiveness of a new model of patient decision support concerning MS-immunotherapy options. The delegation of treatment information provision from physicians to trained nurses bears the potential to change current doctor-focused practice in Germany.Trial registrationCurrent Controlled Trials (identifier: ISRCTN37929939), May 27, 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0611-7) contains supplementary material, which is available to authorized users.

Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study.

BackgroundAlthough children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections).MethodsPre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children’s hospital. Parent–child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention.ResultsOf 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent–child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making.ConclusionDecision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.

Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study.

BackgroundShared decision making (SDM) may narrow health equity gaps experienced by Aboriginal women. SDM tools such as patient decision aids can facilitate SDM between the client and health care providers; SDM tools for use in Western health care settings have not yet been developed for and with Aboriginal populations. This study describes the adaptation and usability testing of a SDM tool, the Ottawa Personal Decision Guide (OPDG), to support decision making by Aboriginal women.MethodsAn interpretive descriptive qualitative study was structured by the Ottawa Decision Support Framework and used a postcolonial theoretical lens. An advisory group was established with representation from the Aboriginal community and used a mutually agreed-upon ethical framework. Eligible participants were Aboriginal women at Minwaashin Lodge. First, the OPDG was discussed in focus groups using a semi-structured interview guide. Then, individual usability interviews were conducted using a semi-structured interview guide with decision coaching. Iterative adaptations to the OPDG were made during focus groups and usability interviews until saturation was reached. Transcripts were coded using thematic analysis and themes confirmed in collaboration with an advisory group.ResultsAboriginal women 20 to 60 years of age and self-identifying as First Nations, Métis, or Inuit participated in two focus groups (n = 13) or usability interviews (n = 6). Seven themes were developed that either reflected or affirmed OPDG adaptions: 1) “This paper makes it hard for me to show that I am capable of making decisions”; 2) “I am responsible for my decisions”; 3) “My past and current experiences affect the way I make decisions”; 4) “People need to talk with people”; 5) “I need to fully participate in making my decisions”; 6) “I need to explore my decision in a meaningful way”; 7) “I need respect for my traditional learning and communication style”.ConclusionsAdaptations resulted in a culturally adapted version of the OPDG that better met the needs of Aboriginal women participants and was more accessible with respect to health literacy assumptions. Decision coaching was identified as required to enhance engagement in the decision making process and using the adapted OPDG as a talking guide.

Interventions to support children's engagement in health-related decisions: a systematic review.

BackgroundChildren often need support in health decision-making. The objective of this study was to review characteristics and effectiveness of interventions that support health decision-making of children.MethodsA systematic review. Electronic databases (PubMed, the Cochrane Library, Web of Science, Scopus, ProQuest Dissertations and Theses, CINAHL, PsycINFO, MEDLINE, and EMBASE) were searched from inception until March 2012. Two independent reviewers screened eligibility: a) intervention studies; b) involved supporting children (≤18 years) considering health-related decision(s); and c) measured decision quality or decision-making process outcomes. Data extraction and quality appraisal were conducted by one author and verified by another using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias tool.ResultsOf 4313 citations, 5 studies were eligible. Interventions focused on supporting decisions about risk behaviors (n = 3), psycho-educational services (n = 1), and end of life (n = 1). Two of 5 studies had statistically significant findings: i) compared to attention placebo, decision coaching alone increased values congruence between child and parent, and child satisfaction with decision-making process (lower risk of bias); ii) compared to no intervention, a workshop with weekly assignments increased overall decision-making quality (higher risk of bias).ConclusionsFew studies have focused on interventions to support children’s participation in decisions about their health. More research is needed to determine effective methods for supporting children’s health decision-making.

Design and Testing of Tools for Shared Decision Making

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 …

Systematic review of interventions to support well-informed person-centered decision making for dementia care

Introduction: Creating dementia care plans can reduce caregiver burden and prolong aging in place. However, family caregivers state that surrogate decision making is a primary source of burden and a barrier to creating care plans. Decision support interventions (e.g. patients’ decision aids, decision coaching, etc.) have been shown to improve information comprehension, communication, decisional conflict, and engagement in decision making. However, the quantity, quality, and effects of decision support interventions for dementia families remain unclear. Therefore, this systematic review critically assessed the scientific literature regarding the following research question: Compared with usual care, do individuals with dementia and/or their family caregivers who receive a decision support intervention have improved information comprehension, decisional conflict, or engagement in decision making? Methods: Two research librarians searched the MEDLINE, CINAHL, EMBASE, Cochrane, Web of Knowledge, Google Scholar, PsychInfo, and related dissertation libraries for “dementia”,”decision support”, and related sub-terms. Three researchers hand-searched abstracts from relevant academic society meetings, and spoke with identified experts in the field. Eligibility criteria included papers about individuals with dementia or their family caregivers using any form of intervention designed to support health care decision making. Primary outcomes included information comprehension, decisional conflict, and engagement in decision making. Critical appraisal followed the Cochrane and GRADE guidelines. Results: Two blinded reviewers reviewed 5,922 abstracts and 131 full text manuscripts to yield 14 included papers reporting on 9 decision aids designed specifically for dementia care. These papers were published in 2001-2012 and describe studies in the United States, United Kingdom, Canada, France, Germany, The Netherlands, and Australia. Nine decision aids were identified covering topics such as advanced care plan options, respite care, antibiotics, feeding tubes, goals of care, long term care, and memory medications. These decision aids exist in paper workbook and video/DVD media. Three decision aids are reported available on the Internet, but studies evaluating Internet-delivery were limited. The majority of studies (66%) focused on caregivers’ decision making. Critical analyses suggest moderate effects on information comprehension and decisional conflict; however, insufficient information was provided to critically assess the effect on engagement in decision making. Risk of bias varied, as many studies reported on early development stages. Conclusions: Since 2001, nine patients’ decision aids have been developed internationally for decisions related to dementia care. Early evidence suggests dementia care decision aids can improve information comprehension and decisional conflict similar to other decision aids; however, gaps remain in the evidence regarding their effect on engagement in creating care plans.

Decision Coaching to Prepare Patients for Making Health Decisions

Decision coaching is individualized, nondirective facilitation of patient preparation for shared decision making. To explore characteristics and effectiveness of decision coaching evaluated within trials of patient decision aids (PtDAs) for health decisions. A subanalysis of trials included in the 2011 Cochrane Review of PtDAs. Eligible trials allowed the effectiveness of decision coaching to be compared with another intervention and/or usual care. Two reviewers independently screened 86 trials, extracted data, and appraised quality. Ten trials were eligible. Decision coaching was provided by genetic counselors, nurses, pharmacists, physicians, psychologists, or health educators. Coaching compared with usual care (n = 1 trial) improved knowledge. Coaching plus PtDA compared with usual care (n = 4) improved knowledge and participation in decision making without reported dissatisfaction. Coaching compared with PtDA alone (n = 4) increased values-choice agreement and improved satisfaction with the decision-making process without any difference in knowledge or participation in decision making. Coaching plus PtDA compared with PtDA alone (n = 4) had no difference in knowledge, values-choice agreement, participation in decision making, or satisfaction with the process. Decision coaching plus PtDA was more cost-effective compared with PtDA alone or usual care (n = 1). Methodological quality, number of trials, and description of decision coaching. Compared with usual care, decision coaching improved knowledge. However, the improvement in knowledge was similar when coaching was compared with PtDA alone. Outcomes for other comparisons are more variable, some trials showing positive effects and other trials reporting no difference. Given the small number of trials and variability in results, further research is required to determine the effectiveness of decision coaching.