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20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework

Author

Listed:
  • Dawn Stacey

    (School of Nursing, University of Ottawa, Ottawa, ON, Canada
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada)

  • France Légaré

    (Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
    Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada)

  • Laura Boland

    (Western University, School of Health Studies, London, Canada
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada)

  • Krystina B. Lewis

    (School of Nursing, University of Ottawa, Ottawa, ON, Canada)

  • Marie-Chantal Loiselle

    (School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada)

  • Lauren Hoefel

    (School of Nursing, University of Ottawa, Ottawa, ON, Canada)

  • Mirjam Garvelink

    (Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, the Netherlands)

  • Annette O’Connor

    (School of Nursing, University of Ottawa, Ottawa, ON, Canada)

Abstract

Introduction. The Ottawa Decision Support Framework (ODSF) has guided practitioners and patients facing difficult decisions for 20 years. It asserts that decision support interventions that address patients’ decisional needs improve decision quality. Purpose. To update the ODSF based on a synthesis of evidence. Methods . We conducted an overview of systematic reviews, searching 9 electronic databases. Eligible reviews included decisional needs assessments, decision support interventions, and decisional outcome measures guided by the ODSF. We extracted data and synthesized results narratively. Eight ODSF developers/expert users from 4 disciplines revised the ODSF. Results. Of 4656 citations, we identified 4 eligible reviews (>250 studies, >100 different decisions, >50,000 patients, 18 countries, 5 continents). They reported current ODSF decisional needs and their most frequent manifestations in the areas of inadequate knowledge/information, unclear values, decisional conflict/uncertainty, and inadequate support. They uncovered 11 new manifestations of 6 decisional needs. Using the Decisional Conflict Scale (DCS) to assess decisional needs, average scores were elevated at baseline and declined shortly after decision making, even without information interventions. Patient decision aids were superior to usual care in reducing total DCS scores and improving decision quality. We revised the ODSF by refining definitions of 6 decisional needs and adding new interventions to address 4 needs. We added a decision process outcome and eliminated secondary outcomes unlikely to improve across a range of decisions, retaining the implementation/continuance of the chosen option and appropriate use/costs of health services. Conclusions . We updated the ODSF to reflect the current evidence and identified implications for practice and further research.

Suggested Citation

  • Dawn Stacey & France Légaré & Laura Boland & Krystina B. Lewis & Marie-Chantal Loiselle & Lauren Hoefel & Mirjam Garvelink & Annette O’Connor, 2020. "20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework," Medical Decision Making, , vol. 40(3), pages 379-398, April.
  • Handle: RePEc:sae:medema:v:40:y:2020:i:3:p:379-398
    DOI: 10.1177/0272989X20911870
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    Citations

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    Cited by:

    1. Holly O. Witteman & Kristin G. Maki & Gratianne Vaisson & Jeanette Finderup & Krystina B. Lewis & Karina Dahl Steffensen & Caroline Beaudoin & Sandrine Comeau & Robert J. Volk, 2021. "Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration," Medical Decision Making, , vol. 41(7), pages 736-754, October.
    2. Yueh-Ling Liao & Tsae-Jyy Wang & Chien-Wei Su & Shu-Yuan Liang & Chieh-Yu Liu & Jun-Yu Fan, 2023. "Efficacy of a Decision Support Intervention on Decisional Conflict Related to Hepatocellular Cancer Treatment: A Randomized Controlled Trial," Clinical Nursing Research, , vol. 32(1), pages 233-243, January.
    3. Yulia Gendler & Ayala Blau, 2024. "Exploring Cultural and Religious Effects on HPV Vaccination Decision Making Using a Web-Based Decision Aid: A Quasi-experimental Study," Medical Decision Making, , vol. 44(4), pages 426-436, May.
    4. Anne Christin Rahn & Janet Jull & Laura Boland & Jeanette Finderup & Marie-Chantal Loiselle & Maureen Smith & Sascha Köpke & Dawn Stacey, 2021. "Guidance and/or Decision Coaching with Patient Decision Aids: Scoping Reviews to Inform the International Patient Decision Aid Standards (IPDAS)," Medical Decision Making, , vol. 41(7), pages 938-953, October.

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