Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: A systematic review

Claudia Caroline Dobler, Manuel Sanchez, Michael R. Gionfriddo, Neri A. Alvarez-Villalobos, Naykky Singh Ospina, Gabriela Spencer-Bonilla, Bjorg Thorsteinsdottir, Raed Benkhadra, Patricia J. Erwin, Colin P. West, Juan P. Brito, Mohammad Hassan Murad, Victor M. Montori

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Background: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. Methods: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Results: Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians' satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Conclusion: Decision aids can improve clinicians' satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians' perspective on the decision making process or the likelihood of using a decision aid in the future.

Original languageEnglish
Pages (from-to)499-510
Number of pages12
JournalBMJ Quality and Safety
Volume28
Issue number6
Early online date1 Jan 2018
DOIs
Publication statusPublished - Jun 2019
Externally publishedYes

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Decision Support Techniques
Referral and Consultation
Decision Making
Randomized Controlled Trials
Therapeutics
Prenatal Diagnosis
Respiratory Tract Infections
Osteoporosis
Diabetes Mellitus
Outpatients
Databases
Depression
Anti-Bacterial Agents
Delivery of Health Care
Control Groups

Cite this

Dobler, C. C., Sanchez, M., Gionfriddo, M. R., Alvarez-Villalobos, N. A., Singh Ospina, N., Spencer-Bonilla, G., ... Montori, V. M. (2019). Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: A systematic review. BMJ Quality and Safety, 28(6), 499-510. https://doi.org/10.1136/bmjqs-2018-008022
Dobler, Claudia Caroline ; Sanchez, Manuel ; Gionfriddo, Michael R. ; Alvarez-Villalobos, Neri A. ; Singh Ospina, Naykky ; Spencer-Bonilla, Gabriela ; Thorsteinsdottir, Bjorg ; Benkhadra, Raed ; Erwin, Patricia J. ; West, Colin P. ; Brito, Juan P. ; Murad, Mohammad Hassan ; Montori, Victor M. / Impact of decision aids used during clinical encounters on clinician outcomes and consultation length : A systematic review. In: BMJ Quality and Safety. 2019 ; Vol. 28, No. 6. pp. 499-510.
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abstract = "Background: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. Methods: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Results: Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians' satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Conclusion: Decision aids can improve clinicians' satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians' perspective on the decision making process or the likelihood of using a decision aid in the future.",
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Dobler, CC, Sanchez, M, Gionfriddo, MR, Alvarez-Villalobos, NA, Singh Ospina, N, Spencer-Bonilla, G, Thorsteinsdottir, B, Benkhadra, R, Erwin, PJ, West, CP, Brito, JP, Murad, MH & Montori, VM 2019, 'Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: A systematic review' BMJ Quality and Safety, vol. 28, no. 6, pp. 499-510. https://doi.org/10.1136/bmjqs-2018-008022

Impact of decision aids used during clinical encounters on clinician outcomes and consultation length : A systematic review. / Dobler, Claudia Caroline; Sanchez, Manuel; Gionfriddo, Michael R.; Alvarez-Villalobos, Neri A.; Singh Ospina, Naykky; Spencer-Bonilla, Gabriela; Thorsteinsdottir, Bjorg; Benkhadra, Raed; Erwin, Patricia J.; West, Colin P.; Brito, Juan P.; Murad, Mohammad Hassan; Montori, Victor M.

In: BMJ Quality and Safety, Vol. 28, No. 6, 06.2019, p. 499-510.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Impact of decision aids used during clinical encounters on clinician outcomes and consultation length

T2 - A systematic review

AU - Dobler, Claudia Caroline

AU - Sanchez, Manuel

AU - Gionfriddo, Michael R.

AU - Alvarez-Villalobos, Neri A.

AU - Singh Ospina, Naykky

AU - Spencer-Bonilla, Gabriela

AU - Thorsteinsdottir, Bjorg

AU - Benkhadra, Raed

AU - Erwin, Patricia J.

AU - West, Colin P.

AU - Brito, Juan P.

AU - Murad, Mohammad Hassan

AU - Montori, Victor M.

PY - 2019/6

Y1 - 2019/6

N2 - Background: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. Methods: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Results: Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians' satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Conclusion: Decision aids can improve clinicians' satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians' perspective on the decision making process or the likelihood of using a decision aid in the future.

AB - Background: Clinicians' satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes. Methods: We searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach. Results: Twenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians' satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors. Conclusion: Decision aids can improve clinicians' satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians' perspective on the decision making process or the likelihood of using a decision aid in the future.

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DO - 10.1136/bmjqs-2018-008022

M3 - Article

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SP - 499

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JO - Quality and Safety in Health Care

JF - Quality and Safety in Health Care

SN - 1475-3898

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