The impact and utility of encounter patient decision aids: Systematic review, meta-analysis and narrative synthesis.

Autor: Scalia P; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Peter.Scalia@dartmouth.edu., Durand MA; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Marie-Anne.Durand@dartmouth.edu., Berkowitz JL; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Julia.L.Berkowitz.med@dartmouth.edu., Ramesh NP; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Nithya.Puttige.Ramesh@dartmouth.edu., Faber MJ; Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands. Electronic address: marjan.faber@radboudumc.nl., Kremer JAM; Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands. Electronic address: jan.kremer@radboudumc.nl., Elwyn G; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: glynelwyn@gmail.com.
Jazyk: angličtina
Zdroj: Patient education and counseling [Patient Educ Couns] 2019 May; Vol. 102 (5), pp. 817-841. Date of Electronic Publication: 2018 Dec 21.
DOI: 10.1016/j.pec.2018.12.020
Abstrakt: Objective: To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows.
Methods: Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies.
Results: We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD = 0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD = 0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR = 1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level.
Conclusion: Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers.
Practical Implications: The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice.
(Copyright © 2018 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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