Title
Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: A systematic review
Date Issued
01 June 2019
Access level
open access
Resource Type
review article
Author(s)
Dobler C.C.
Sanchez M.
Gionfriddo M.R.
Alvarez-Villalobos N.A.
Singh Ospina N.
Spencer-Bonilla G.
Thorsteinsdottir B.
Benkhadra R.
Erwin P.J.
West C.P.
Brito J.P.
Murad M.H.
Publisher(s)
BMJ Publishing Group
Abstract
Background Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. Methods We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Results Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians' satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Conclusion Decision aids can improve clinicians' satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians' perspective on the decision making process or the likelihood of using a decision aid in the future.
Start page
499
End page
510
Volume
28
Issue
6
Language
English
OCDE Knowledge area
Otros temas de medicina clínica
Scopus EID
2-s2.0-85054620216
PubMed ID
Source
BMJ Quality and Safety
ISSN of the container
20445415
Source funding
National Institute on Aging
National Health and Medical Research Council
Sources of information: Directorio de Producción Científica Scopus