“When my husband was faced with a major decision between surgery and radiation for his cancer treatment, we were overwhelmed by the different perspectives from the specialists — each one focusing only on their own treatment. No one put the options side by side. That’s where the patient decision aids made all the difference. We felt empowered, informed, and confident in the choice we made — knowing we had truly considered every option.” — Maureen Smith, caregiver and patient advocate.
Patient decision aids (PDAs), like the one Maureen and her husband used, are evidence-based tools that help individuals make informed decisions about their healthcare. These tools help patients understand the benefits and risks of each option while clarifying their personal values. Often, decision aids include visual tools such as charts or diagrams to simplify complex medical data, making it easier for patients to grasp the implications of their choices. PDAs also encourage collaboration between patients and healthcare providers, ensuring that decisions align with both medical expertise and the patient’s informed preferences.
A Cochrane review led by Professor Dawn Stacey analyzed data from over 200 studies and found that PDAs significantly improve patient knowledge, reduce decisional conflict, and support informed, values-based choices. The review examined decision aids used across 71 different health decisions, including cardiovascular treatments, cancer screening, mental health care, and joint replacement surgery. Stacey, who has led the review since 2010, explained that the evidence supporting PDAs has only grown stronger over time, showing their positive impact on both decision-making processes and the quality of decisions themselves. PDAs are particularly useful for preparing patients and their family members to take a more active role in making decisions.
Maureen’s experience reflects this impact. As her husband's primary caregiver, they received information from two different specialists; each focused on their specific treatment without offering a full comparison of options. Feeling overwhelmed, Maureen turned to patient decision aids that she had learned about through her research involvement. Sitting together at their kitchen table, they used the decision aid on their laptops, reviewing the pros and cons of surgery versus radiation in detail.
“We took our time, discussing each part and revisiting the options when needed,” says Maureen. “It allowed us to compare the options side by side, understand the long-term consequences, and align the decision with what was truly important to my husband.” This process transformed an overwhelming situation into a structured, informed journey where both Maureen and her husband felt prepared and supported.
Ultimately, her husband opted for surgery, confident that they had fully weighed all the options. Today, Maureen looks back with gratitude, knowing the decision aid gave them control during a difficult time in their lives. “We knew we had considered everything, and that gave us peace of mind.”
PDAs also provide broader benefits. According to Dawn Stacey, PDAs empower patients by improving their knowledge and understanding of the treatment options available. "Patients feel more prepared because now when they are in the consultation, they are not trying to learn everything being said by the doctor or nurse practitioner," says Stacey. PDAs give patients the tools to ask better questions and engage in meaningful discussions about their treatment. This improved communication reduces decisional conflict and patients feel more confident in the choices they make.
Transforming care through global implementation
The use of decision aids is also transforming healthcare systems globally. Following the January 2024 update of the Cochrane Review, Brazil is set to integrate PDAs into its national healthcare system. This initiative seeks to shift Brazil's traditionally paternalistic healthcare model—where doctors often hold the primary decision-making power—toward a more patient-centered approach. Juliana Sousa, a project leader, emphasized the project's goal: “We want to empower patients to have a voice in their healthcare decisions, moving away from the provider-dominated approach to one where patient input is valued.”
The project, currently in its formative stage, involves collaboration between Brazilian healthcare experts, international partners, and the authors of the Cochrane review. The team will test the implementation in primary care settings and home care programs to evaluate its impact on patient-provider communication and healthcare outcomes. Running until 2026, the initiative plans to integrate PDAs into digital healthcare platforms managed by the Ministry of Health, ensuring that decision aids cover a wide range of medical conditions.
Before the January 2024 Cochrane Review update, several countries had already implemented PDAs into their healthcare systems. In the UK, the National Institute for Health and Care Excellence (NICE) incorporated PDAs into clinical guidelines, promoting their use to improve patient experience and support shared decision-making across various medical fields. Germany has launched large-scale projects, such as the “SHARE TO CARE” initiative, which integrates shared decision-making across healthcare settings with support from health insurers. Similarly, Denmark’s efforts, particularly in the Region of Southern Denmark, involve over 25,000 healthcare professionals across major hospitals like Odense University Hospital. These initiatives are backed by national policies that encourage patient involvement and evidence-based decision-making.
In Taiwan, the Joint Commission of Taiwan (JCT), under the Ministry of Health and Welfare, has developed a nationwide project focusing on integrating shared decision-making into clinical practice. This project aims to improve communication between healthcare providers and patients, ensuring treatment decisions align with patients' values and preferences.
These global initiatives highlight the increasing acceptance of PDAs in modern healthcare. However, while the benefits of PDAs are clear, Stacey says there is need for more widespread implementation to ensure their full potential is realized. “Healthcare professionals need to have training in how to involve patients in decision-making and change their approach to how they discuss options with patients," Stacey explains. She added that PDAs work best when healthcare teams—not just individual doctors—are trained to use them effectively. Patients, too, need to be encouraged to take an active role in their healthcare decisions.
Stacey's message is clear, "Patient decision aids work. But they only work if they are used." The next steps involve ensuring that PDAs are integrated into routine healthcare practices globally, with adequate training for healthcare professionals and increased awareness for patients.
Wednesday, October 23, 2024
