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General medicine
Problem with patient decision aids
  1. Joshua R Zadro1,
  2. Adrian C Traeger1,
  3. Simon Décary2,
  4. Mary O'Keeffe1,3
  1. 1Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne, de l’Université Laval, Quebec City, Quebec, Canada
  3. 3School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, Limeric, Ireland
  1. Correspondence to Dr Joshua R Zadro, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia; joshua.zadro{at}sydney.edu.au

Abstract

Patient decision aids are evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. Research shows that patient decision aids increase knowledge, accuracy of risk perceptions, alignment of care with patient values and preferences, and patient involvement in decision making. Some patient decision aids can reduce the use of invasive and potentially low-value procedures. On this basis, clinical practice guidelines and international organisations have begun to recommend the use of patient decision aids and shared decision making as a strategy to reduce medical overuse. Although patient decision aids hold promise for improving healthcare, there are fundamental issues with patient decision aids that need to be addressed before further progress can be made. The problems with patient decision aids are: (1) Guidelines for developing patient decision aids may not be sufficient to ensure developers select the best available evidence and present it appropriately; (2) Biased presentation of low-certainty evidence is common and (3) Biased presentation of low-certainty evidence is misleading, and could inadvertently support, low-value care. We explore these issues in the article and present a case study of online patient decision aids for musculoskeletal pain. We suggest ways to ensure patient decision aids help patients understand the evidence and, where possible, support high-quality care.

  • quality in health care
  • rehabilitation medicine
  • back pain
  • knee
  • musculoskeletal disorders
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Footnotes

  • Twitter @zadro_josh

  • Contributors JRZ: conception and design, analysis and interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published. ACT: conception and design, interpretation of data, drafting and revision of the manuscript and final approval of the version to be published. SD: conception and design, interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published. MO: conception and design, interpretation of data, drafting and revision of the manuscript, and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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