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A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

Author

Listed:
  • Renata W. Yen

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Jenna Smith

    (Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia)

  • Jaclyn Engel

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • Danielle Marie Muscat

    (Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia)

  • Sian K. Smith

    (University of Bath, School of Management, Bath, Somerset, UK)

  • Julien Mancini

    (Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d’Azu, France)

  • Lilisbeth Perestelo-Pérez

    (Evaluation Unit (SESCS), Canary Islands Health Service (SCS), REDISSEC, Tenerife, Spain)

  • Glyn Elwyn

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA)

  • A. James O’Malley

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
    Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA)

  • JoAnna K. Leyenaar

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
    Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA)

  • Olivia Mac

    (Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia)

  • Tamara Cadet

    (School of Social Work, Simmons University, Boston, MA, USA
    Harvard School of Dental Medicine, Boston, MA, USA)

  • Anik Giguere

    (Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada)

  • Ashley J. Housten

    (Washington University School of Medicine, St Louis, MO, USA)

  • Aisha Langford

    (New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA)

  • Kirsten McCaffery

    (Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia)

  • Marie-Anne Durand

    (The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
    Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France)

Abstract

Background The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. Purpose To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. Data Sources MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. Study Selection Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. Data Extraction Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. Data Synthesis Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I 2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I 2 = 0%]). PtDAs reduced decisional conflict (mean difference = −9.59; 95% CI −18.94, −0.24 [I 2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I 2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI −0.22, 0.26 [I 2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. Limitations Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. Conclusions PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective. Highlights Systematic review and meta-analysis of patient decision aids and other shared decision-making (SDM) interventions for disadvantaged populations. Patient decision aids and other SDM interventions improve patient-reported outcomes for disadvantaged populations. There was no evidence on what intervention characteristics best supported disadvantaged populations.

Suggested Citation

  • Renata W. Yen & Jenna Smith & Jaclyn Engel & Danielle Marie Muscat & Sian K. Smith & Julien Mancini & Lilisbeth Perestelo-Pérez & Glyn Elwyn & A. James O’Malley & JoAnna K. Leyenaar & Olivia Mac & , 2021. "A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)," Medical Decision Making, , vol. 41(7), pages 870-896, October.
    • Handle: RePEc:sae:medema:v:41:y:2021:i:7:p:870-896
    DOI: 10.1177/0272989X211020317
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    References listed on IDEAS

    as
    1. Danielle M. Muscat & Jenna Smith & Olivia Mac & Tamara Cadet & Anik Giguere & Ashley J. Housten & Aisha T. Langford & Sian K. Smith & Marie-Anne Durand & Kirsten McCaffery, 2021. "Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards," Medical Decision Making, , vol. 41(7), pages 848-869, October.
    2. Kristin L. Rising & Judd E. Hollander & Jason T. Schaffer & Jeffrey A. Kline & Carlos A. Torres & Deborah B. Diercks & Russell Jones & Kelly P. Owen & Zachary F. Meisel & Michel Demers & Annie Leblanc, 2018. "Effectiveness of a Decision Aid in Potentially Vulnerable Patients: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial," Medical Decision Making, , vol. 38(1), pages 69-78, January.
    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    4. Marie-Anne Durand & Lewis Carpenter & Hayley Dolan & Paulina Bravo & Mala Mann & Frances Bunn & Glyn Elwyn, 2014. "Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-13, April.
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    Cited by:

    1. Benjamin Miranda Tabak & Matheus B. Froner & Rafael Corrêa & Thiago C. Silva, 2023. "The Intersection of Health Literacy and Public Health: A Machine Learning-Enhanced Bibliometric Investigation," IJERPH, MDPI, vol. 20(20), pages 1-18, October.
    2. Dawn Stacey & Robert J. Volk, 2021. "The International Patient Decision Aid Standards (IPDAS) Collaboration: Evidence Update 2.0," Medical Decision Making, , vol. 41(7), pages 729-733, October.

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