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

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

7 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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    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