Are Patient Decision Aids Effective for Chronic Disease Management?

Most medications are prescribed solely based on the professional opinion of the clinician. This leaves little to no room for input from the patient, who will ultimately decide whether or not to continue taking the prescribed medication.

A good portion of chronic disease states has drug classes with equivalent efficacy, so patient-specific factors play an important role in deciding which medication to prescribe. This is where patient decision aids can come into play.

Decision aids take the form of cards that detail information on treatment options for a given disease state, such as medication dosing, benefits, and side effects. These cards are shared with patients so that they may select the medication that they feel most comfortable with.

When decision aids are used, outcomes such as perceived involvement, agreement between values and choice, and decisional conflict move towards a desirable positive direction.¹

One recent study observed the use of decision aids that detail treatment options for depression, and it found that patients reported feeling more knowledgeable and comfortable with the medication that was chosen in comparison to those in the standard care group who were not shown decision aids.²

According to the study authors, 79% of patients in the decision aid arm of the trial stated that they prefer to be the principal decision maker or be involved in medical decisions made by their clinician regarding their care. However, it remains unclear what effect decision aids can have on patient compliance.

Decision aids allow patients to take a proactive approach to their own care, which increases their satisfaction. With decision aids, patients are more comfortable with the therapy they receive and are content with their clinician’s care.

This atmosphere enhances the critical doctor-patient relationship. Because the downstream effect on persistence with decisions, health-related quality of life, and costs have not yet been established,³further research is needed to paint a full picture of the pros and cons of decision aids.

References:

1. Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, et al. Decision aids for people facing health treatment or screening decisions.Cochrane Database Syst Rev2003;(1):CD001431.

2. LeBlanc A, Herrin J, Williams MD, et al. Shared Decision Making for Antidepressants in Primary Care: A Cluster Randomized Trial.JAMA Intern Med.Published online September 28, 2015. doi:10.1001/jamainternmed.2015.5214.

3. O'Connor AM, Fiset V, Degrasse C, Graham I, Evans W, Stacey D, et al. Decision aids for patients considering health care options: evidence of efficacy and policy implications.J Natl Cancer Inst. 1999;(25):67-80.