Cochrane inCORR®: Decision Aids for People Facing Health Treatment or Screening Decisions

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Orthopaedic clinicians must take into account the patient's own values and preferences when making diagnoses or treatment decisions. Consider the scenario in which a surgeon and a patient must together decide between internal fixation and arthroplasty in a 50-year-old laborer with a displaced femoral neck fracture. Each treatment, with its advantages and disadvantages, must be weighed in the context of the patient's values. In this instance, that might mean the patient's willingness to endure a greater risk of reoperation in order to preserve his native femoral head (by undergoing internal fixation), which might make it more likely for him to continue to work at his physical job.
Approaches to decision-making in settings like this include clinician-driven decisions (decisions based on the surgeon's best judgment), and decisions made in tandem with the patient (shared decision-making). In shared decision-making, the surgeon acts as an expert on the facts, and the patient acts as an expert on his or her own values [3]. Patient-oriented decision aids can help patients understand the risks and benefits of all available treatment/diagnosis options by providing impartial evidence-based information in plain language [2]. The goal is to engage patients in their own healthcare decisions in order to better align treatment choices with patients’ preferences [10]. However, the degree to which shared decision-making is possible or helpful, whether it can or should be implemented for all patients in all settings (or even most patients in most settings), and whether it is likely to improve either clinical outcomes or patient satisfaction remain controversial.
This Cochrane review of 115 randomized controlled trials (34,444 patients) found that decision aids improved not only communication between clinicians and patients, but also patients’ knowledge about the procedure or diagnosis, the accuracy of patients’ perceptions (particularly regarding probabilities), and patient comfort with the chosen option [9]. Decision aids also helped patients choose options that are matched with their values.
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