PT - JOURNAL ARTICLE AU - Joshua R Zadro AU - Adrian C Traeger AU - Simon Décary AU - Mary O'Keeffe TI - Problem with patient decision aids AID - 10.1136/bmjebm-2020-111371 DP - 2021 Aug 01 TA - BMJ Evidence-Based Medicine PG - 180--183 VI - 26 IP - 4 4099 - http://ebm.bmj.com/content/26/4/180.short 4100 - http://ebm.bmj.com/content/26/4/180.full SO - BMJ EBM2021 Aug 01; 26 AB - 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.