'What happens if I do nothing?' A Systematic Review of the Inclusion and Quantitative Description of a 'No Active Intervention' Option in Patient Decision Aids

The tendency of patients and clinicians to overestimate intervention benefits is an acknowledged contributor to healthcare overuse.1,2 For many conditions, not actively intervening is a legitimate option, such as for self-limiting conditions which can resolve without intervention (other than for symptom management), for conditions where ‘wait and watch’ is appropriate, or where not having a screen or test is reasonable. As part of shared decision-making and campaigns such as Choosing Wisely,3 patients are encouraged to ask ‘what happens if I do nothing?’. To help patients construct informed preferences and decisions congruent with their values, part of a decision aid’s role can be to correct misperceptions about the benefits and harms of intervention options, including not intervening.4 For conditions where not actively intervening is reasonable, informed decision-making requires discussion about the condition’s natural history, such as timeframes to recovery or other likely consequences. We aimed to analyze the inclusion and quantitative description of a ‘no active intervention’ option in all publicly available decision aids.