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084 Supporting older patients in making healthcare decisions: the effectiveness of decision aids; a systematic review and meta-analysis
  1. Emma A Gans1,2,
  2. Liza AM van Mun2,
  3. Janke F de Groot2,
  4. Barbara C van Munster1,
  5. Estera Rake2,
  6. Julia CM van Weert3,
  7. Suzanne Festen1,
  8. Frederiek van den Bos4
  1. 1University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands
  2. 2Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
  3. 3Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
  4. 4Department of Gerontology and Geriatrics, Leiden University

Abstract

Introduction Health care decisions are complex in the older adult population.1 Treatment-specific outcome data is often limited, and health-related goals and priorities are heterogenous.2 To support decision-making, decision aids (DAs) have been developed. Literature shows that age-related cognitive changes may influence decision-making.3–5 Therefore, we aim to systematically review randomized and clinical controlled trials evaluating the effectiveness of DAs compared to usual care or alternative interventions for older patients facing treatment, screening, or care decisions.

Methods A systematic search of several databases was conducted. Eligible studies included patients ≥65 years or reported a mean age ≥70 years. Primary outcomes were attributes of the choice made and decision- making process, user experience, and ways in which DAs were tailored to older patients. Meta-analysis was conducted, if possible, or outcomes were synthesized descriptively.

Results Overall, 15 studies were included. DAs were effective in increasing knowledge (SMD 0.90; 95% CI [0.48, 1.32]), decreasing decisional conflict (SMD −0.15; 95% CI [−0.29, −0.01]), improving patient-provider communication (RR 1.67; 95% CI [1.21, 2.29]), and preparing patients to make an individualized decision (MD 35.7%; 95% CI [26.8, 44.6]). No effect was found on decision-making satisfaction (SDM 0.03; 95% CI [-0.17, -0.23]). No evidence was found on quality of shared decision making and risk perception. Nine studies provided details on how the DA was tailored to older patients.

Discussion This review shows favorable results on the effectiveness of DAs to support decision making with older patients. Whether a DA is a suitable tool for older adults with frailty and/or cognitive impairment remains uncertain.

Conclusion(s) DAs can be used to support shared decision making with older patients when faced with treatment, screening, or care decisions.

References

  1. O’Connor AM, CMAJ Can Med Assoc J. 2007;176(11):1597–1598.

  2. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L. Cochrane Database Syst Rev 2017;4(4).

  3. Mata R, Schooler LJ, Rieskamp J. Psychol Aging. 2007;22(4):796–810.

  4. Hanoch Y, Wood S, Rice T, Hum Dev. 2007;50:333–358.

  5. Peters E, Hess TM, Västfjäll D, AumanC, Perspect Psychol Sci. 2007;2(1):1–23.

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