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Interventions that target patients, healthcare providers, or both may increase shared decision-making, but patients do not consistently report benefits

Légaré F, Stacey D, Turcotte S, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014;9:CD006732.

Review question

How effective are interventions aimed at improving healthcare providers’ use of shared decision-making by targeting patients, professionals, or both?

Background

Shared decision-making involves patients working with their healthcare providers, using the best available evidence and the patient’s preferences and values, to make decisions about the best healthcare actions. Interventions to increase shared decision-making may be aimed at healthcare providers, patients, or both.

How the review was done

The researchers did a systematic review, searching for studies available up to August 2012. They found 39 studies, including 38 randomized controlled trials.

The interventions targeted patients in 18 studies (4055 people), healthcare providers in 8 studies (more than 593 providers), and both in 13 studies (5474 patients and 571 providers).

A variety of interventions were studied, including use of educational meetings, educational materials, paper and internet-based decision aids, and audit and feedback directed toward patients and/or healthcare providers.

Outcomes were categorized as patient-reported measures (such as how much control a patient believes he or she has in decision-making or how satisfied a patient is) or observer-based measures (objective measures of how much healthcare providers involve patients in making decisions).

What the researchers found

Evidence was of low or very low quality.

Compared with usual care, most interventions that targeted patients, healthcare providers, or both patients and providers improved the likelihood of shared decision-making according to observers, but not consistently according to patients.

Compared with interventions that targeted patients only:

  • interventions that targeted healthcare providers only did not improve the likelihood of shared decision-making according to patients; and
  • interventions that targeted both patients and healthcare providers improved the likelihood of shared decision-making according to observers, but not according to patients.

Conclusions

The quality of evidence about interventions to improve shared decision-making is low. Interventions that target patients or healthcare providers or both can increase use of shared decision-making according to observers but not according to patients.

Interventions to increase shared decision-making*

Target of intervention

Target of comparator

Findings†

Patients

Usual care

Small improvement in patient-reported measures (4 studies)

Healthcare providers

Usual care

Large improvement in observer-based measures (3 studies)

No improvement in patient-reported measures (1 study)

 

Patients

No improvement in patient-reported measures (2 study)

Patients and healthcare providers

Usual care

Large improvement in observer-based measures (2 studies)

No difference in patient-reported measures (3 studies)

 

Patients

Large improvement in observer-based measures (1 study)

No improvement in patient-reported measures (3 studies)

*Findings reported are based on continuous measures.

†Based on standard mean differences (SMD): small improvement = 0.2 to 0.49 SMD, medium improvement = 0.5 to 0.79, large improvement = 0.8 or more.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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