Healthcare decisions are often complex, and, in many cases, the best choice depends on patient preferences and how individuals value the risks and benefits of different options. In such cases, it is recommended that patients and clinicians engage in shared decision-making, a collaborative process that considers the best available clinical evidence and the patients’ informed preferences. Patient decision aids are evidence-based tools to support shared decision-making. They include pamphlets, videos, or web-based resources that describe the decision, the options, and help people think about what features are most important to them. These evidence-based tools are specially designed to support individuals in making informed choices aligned with their values and preferences.
Dr. Logan Trenaman, an Assistant Professor in the Department of Health Systems and Population Health, is the co-author of the Cochrane Systematic Review of patient decision aids, which was updated and released in early 2024. According to Dr. Trenaman, the updated findings re-affirm what has been known for some time:
“Compared to usual care, patient decision aids increase patients’ knowledge, their participation in decision-making, and help them make decisions that are aligned with their preferences. Further, there is no evidence of negative effects, like increased decisional regret, associated with their use.”
– Dr Logan Trenaman
The Cochrane Review of Patient Decision Aids:
This Cochrane review, initiated in 2003, plays a pivotal role in summarizing the existing evidence on the impact of these tools. It is the most referenced review in the Cochrane collection (over 8400 citations). In their 2024 update, Dr. Logan Trenaman and the Cochrane team identified 104 new randomized controlled trials of patient decision aids. This brings the total number of trials in the review to 209, spanning 71 different health care decisions (and including nearly 110,000 patients – enough to fill Husky Stadium one and half times).
Cochrane Reviews provide a comprehensive and systematic analysis of a specific healthcare topic and are conducted by the Cochrane Collaboration—an international network of researchers, healthcare professionals, patients, and policymakers. These reviews follow a rigorous methodology, and synthesize data from randomized controlled trials and other high-quality studies to provide a reliable overview of the available evidence. Cochrane Reviews can be valuable resources for healthcare professionals, policymakers, and patients, offering evidence-based insights that guide informed decision-making and contribute to advancements in medical knowledge and practice.
Implications and Future Directions
The implications of the findings for care delivery are profound. “All health systems want to provide high-value patient-centered care. These findings emphasize that patient decision aids are evidence-based interventions that can help support this aim,” said Dr. Trenaman. The findings also highlight an important priority: ensuring that these decision aids get into the hands of patients. “With a substantial evidence base demonstrating their effectiveness, this review highlights the importance of implementing patient decision aids into routine practice,” said Dr. Trenaman.
Washington State’s Leadership in Shared Decision-Making
Washington State has long been a global leader in supporting shared decision-making through policy. In 2007, Washington passed legislation that officially recognized shared decision making using certified high-quality patient decision aids, as a higher standard of informed consent. Washington is the only state in the U.S. that certifies patient decision aids. Since 2012, 50 patient decision aids have been certified, spanning various healthcare decisions, including maternity care, joint replacement, spine care, end-of-life care, and cancer screening.
As healthcare professionals and policymakers seek ways to enhance patient engagement and satisfaction, the incorporation of patient decision aids into standard practice represents an evidence-based strategy. Washington State’s pioneering efforts in certifying decision aids and the robust evidence from the Cochrane review reinforce the importance of integrating these tools into routine clinical practice. As healthcare systems evolve, the focus on empowering patients with the tools and information they need to make decisions aligned with their preferences will undoubtedly contribute to improved outcomes and increased patient satisfaction.