Jury still out on efficacy of patient decision-making aids

Female doctor talking to male patient in hospital bed
Experts at Mayo Clinic said shared decision-making tools may not be all they're cracked up to be. (Getty/monkeybusinessimages)

Policymakers push for increased use of shared decision-making tools to better include patients in their care choices, but the jury is still out on how beneficial these tools truly are, experts say.

A recent Cochrane review suggests that decision aids do help inform patients about their condition and treatment options, according to a report published in the Journal of the American Medical Association. The review found improved knowledge scores and an increased likelihood that patients would choose treatment options that align with their values.

However, the review doesn’t delve deeply enough into whether decision-making aids actually achieve the goals of shared decision-making, a trio of doctors at Mayo Clinic, led by Victor Montori, M.D., write in an accompanying editorial. The review showed mixed results on outcomes, use and costs, and did not significantly reduce the use of invasive or expensive procedures.

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Very few tools were tested in randomized clinical trials, and whether the approach was patient-centered was not thoroughly examined, the doctors add. In fact, decision-making aids may instead encourage patients to make choices irrespective of their physicians’ input, they said.

“Empowering patients who are ill to refuse their clinicians’ recommendations to correct healthcare overuse is also problematic,” they wrote. “Healthcare should provide care for patients and should not use patients as a means to correct systemic problems.”

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The decision-making tools that are likely to be the most effective are conversation aids, as the report found these tools are most aligned with the goals of shared decision-making. Their use requires little work on the patient’s part, and they can be easily prepared ahead of a consultation with a physician.

That said, the approach still requires refinement. A relatively small number of patients used the aids ahead of a conversation with providers, and the length of consultations was roughly the same anyway, about two to three minutes.

Future development in shared decision-making, the authors conclude, should focus less on cost savings, which can be a beneficial byproduct of more effective care choices, and instead on more “careful and kind” care for patients.

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