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Systematic Review
To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach.
There was moderate‐certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants).
Regarding attributes related to the decision‐making process and compared to usual care, there was high‐certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD ‐10.02, 95% CI ‐12.31 to ‐7.74; 58 studies, 12,104 participants), indecision about personal values (MD ‐7.86, 95% CI ‐9.69 to ‐6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision‐making (clinician‐controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants).
For adverse outcomes, there was high‐certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD ‐1.23, 95% CI ‐3.05 to 0.59; 22 studies, 3707 participants).
Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD ‐2.97 minutes, 95% CI ‐7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants).
Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values‐congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision‐making. Our updated review also found that patient decision aids increased patients’ feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.