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285 Updating the evidence for the IPDAS standards: results from a network meta-analysis
  1. Robert J Volk1,
  2. Dawn Stacey2,3,
  3. Krystina B Lewis2,3,
  4. Maureen Smith4,5,
  5. Meg Carley2,
  6. Janet Gunderson4,
  7. Shu-Ching Hseih6,
  8. Shannon Kelly6,
  9. George Wells6,7
  1. 1Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
  2. 2School of Nursing, University of Ottawa, Ottawa, Canada
  3. 3Ottawa Hospital Research Institute, Ottawa, ON, Canada
  4. 4Knowledge User, Ottawa, ON, Canada
  5. 5Cochrane Consumer, Ottawa, ON, Canada
  6. 6University of Ottawa Heart Institute, Ottawa, ON, Canada
  7. 7School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

Abstract

Introduction To update standards for quality and effectiveness of patient decision aids (PtDAs), the International Patient Decision Aid Standards (IPDAS) Collaboration reviewed the evidence supporting the current criteria. Evidence Update 2.0 reviews representing 11 core IPDAS domains were published in 2021. Here we report findings from the Network Meta-Analysis (NMA) used to inform voting on new or revised IPDAS criteria.

Methods NMA was conducted using RCTs from the 2024 Cochrane Review of PtDAs. Six outcome measures were identified for consideration in the NMA (knowledge, accurate risk perceptions, feeling uninformed, unclear values, and feeling undecided). Domain teams submitted questions for the NMA to inform voting on proposed IPDAS criteria changes. NMA was used to test each question by comparing PtDAs with and without specific attributes and to usual care.

Results 149/209 RCTs reported outcomes of interest for NMA and 113 PtDAs were available. No differences were found for PtDAs with explicit vs implicit values clarification. PtDAs that included a risk calculator were associated with poorer knowledge, compared to PtDAs without calculators (MD=2.87, 95%CrI 0.06, 5.67). PtDAs used during consult, compared to independent of consult, were associated with poorer knowledge (MD=-4.34, 95%CrI -7.24, -1.43) and more feeling uninformed (5.07, 95%CrI 1.06, 9.11). Involvement of patients/consumers in the development of PtDAs was associated with better knowledge compared to PtDAs developed only by health care providers (MD=6.56, 95%Crl 1.10,12.03).

Discussion Evidence from NMAs confirmed the importance of certain attributes of PtDAs. Statistically significant results need to be interpreted in the context of minimal clinically important differences.

Conclusions Results from the NMA will be used to inform voting on new or revised criteria. As evidence about the effectiveness of PtDAs continues to expand there will be future opportunities to consider other questions of interest to developers, researchers, and knowledge users.

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