Decision AidImplementing shared decision making

What is a ‘decision aid’?

Authors: Nami Nelson, Professor Dawn Stacey, Associate Professor Sophie Hill

While shared decision making (SDM) is the process of supporting patients (and/or families) to make confident healthcare decisions; a decision aid is a tool that supports this process to help improve the quality of the decision being made. Decision quality is reflected in the ‘..extent to which patients choose and/or receive health care interventions that are congruent with their informed and considered values’ (International Patient Decision Aid Standards, 2017). As a tool, a decision aid is intended to be used as part the decision counselling process; before and/or during consultation with a patient (and/or family) (Stacey, 2014).

Health information resources are frequently thought to be decision aids, but decision aids are much more than simply a source of information or knowledge. A good decision aid will provide information to the patient (and/or family) about their options, but its purpose and structure is as an ‘active’ tool. A decision aid needs to guide and support patients (and/or families) through a process of decision making, to be confident and comfortable with their choice.

Critical elements of a decision aid

There are a wide variety of structures and formats used for healthcare decision aids. They can be online, print, or using video, basically any format which can be used to support the decision process and can ensure critical elements of shared decision making take place. These critical elements of a decision aid are described by Professor Dawn Stacey, Ottawa University, in a Shared Decision Making presentation for the Australian Commission on Safety and Quality in Health care (Stacey, 2014):

  • Provide information: Information about the decision being made and the options available is provided. This includes clearly understood, evidence based information about the harms/benefits of each option. In many cases decision aids have used infographics to convey rates of effectiveness or possible side effects.
  • Clarify values: Section that helps to understand what the patient’s values and preferences are in relation to their care, lifestyle, culture, financial situation and many other considerations. These will have a great influence on how they understand the harms/benefits of each option and their ultimate choice.
  • Deliberation and consideration of options: Activities and worksheets that guide reflection and consideration of how the options, their harms/benefits align with patient (and/or family) preferences.

Templates and guides for understanding what is required in a quality decision aid

Professor Stacey is also the co-author of The Ottawa Personal Decision Guide (OPDG). The OPDG is a strong example of how all these criteria can be covered in a decision aid. While the OPDG sections are blank, it is a template for what needs to be involved in a Shared Decision Making process. Once the sections are filled in with the required information about the decision, decision maker, options, harms/benefits, then it becomes a decision aid. One example to look at, relevant to what is happening today, is to see how the OPDG was used to create the Canadian focused decision aid ‘During the COVID-19 pandemic, should I go to live elsewhere or stay in my retirement/assisted living home?’ (Stacey, D Et al, 2020).

The OPDG is available download in 9 languages and there are templates for both a single decision maker or where there are multiple people involved in the decision process (e.g. patient and a family member).

Another handy resource available to help people understand what is required for a resource to be a decision aid is from the International Personal Decision Aid Standards (IPDAS) Collaboration (IPDAS). IPDAS has published a comprehensive set of evidence based decision aid standards to guide a common approach and help define expectations of what constitutes a quality decision aid.  A checklist of these standards is available online and can be used to audit existing health information resources to identify how they might be upgraded to decision aids, or to plan for and review new decision aids. A library of decision aids that meet the IPDAS standards has been created by Professor Stacey and her team at the Ottawa Hospital Institute of Research. Getting familiar with the IPDAS standards and examples of quality decision aids is a good first step to your own decision aid development. A couple of other hints to keep in mind when thinking about developing decision aids are:

  • Make sure you involve patients and families in the development and review process
  • Base the information on best available evidence
  • Understand what communication styles work best for your patients and families
  • Remember to keep things short, simple and practical.

Ready to get started developing a decision aid?

Before diving in to developing a decision aid. We recommend these actions as a starting point:

  • Audit existing health information and tools: Audit what your health service currently uses to support decision making using the IPDAS checklist [HYPERLINK]. Determine if you might be able to adapt existing resources to be decision aids.
  • Review other examples of quality decision aids: Look at other examples of decision aids that meet IPDAS standards in the decision aid library
  • Get familiar with what using a decision aid means: Role play using the Ottawa Personal Decision Guide. Choose a tricky decision you are faced with in your own life (for example whether to move house; choosing a school for your children; to change bank; accept a new job etc). Go through each section using the OPDG to help you move through the decision making process. This will help you to understand how the OPDG can be used to guide a decision making process and how it can be used as a decision aid.
  • Understand what is effective communication: Talk to patients (and families) about what language, images and communication styles are most effective with the patient/family group who will use your decision aid.
  • Complete the Ottawa Patient Decision Aid Development eTraining: This online program is free and created by the authors of the Ottawa Personal Decision Guide at the Ottawa Hospital Research Institute. This online program will provide a good foundation for any decision aid development activities.

Questions to consider:

  • Can you confidently describe the difference between health information/education materials and a decision aid?
  • Have you already identified a decision that patients need more support with as a focus for your decision aid? If not, what data will you use to identify where a decision aid will be most useful and needed?
  • Have you mapped out how the decision aid will be used and when it will be introduced to the patient and/or family?

References:

International Patient Decision Aid Standards, 2017. Access here: http://ipdas.ohri.ca/what.html

O’Connor, AM; Stacey, D and Jacobsen, MJ, 2015. Ottawa Personal Decision Guide. Ottawa Hospital Research Institute & University of Ottawa, Canada. Access here: https://decisionaid.ohri.ca/decguide.html

Stacey, D, 2014. Patient Decision Aids: Why, What How Where? Presentation for the Australian Commission for Safety and Quality in Health Care. Access here: https://www.safetyandquality.gov.au/our-work/shared-decision-making/shared-decision-making-symposium and https://webcast.gigtv.com.au/Mediasite/Play/211d6484364b48779874d71c57fcadea1d

Stacey, D Et al(2020) During the COVID-19 pandemic, should I go to live elsewhere or stay in my retirement/assisted living home? Ottawa Hospital Research Institute & University of Ottawa, Canada. Access here: https://decisionaid.ohri.ca/docs/das/COVID-MoveFromRetirementHome.pdf

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