Cochrane · systematic review · CD001431

Decision aids for people facing health treatment or screening decisions

Stacey, D, Lewis, KB, Smith, M, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library

Consumers and Communication3 versionsAMSTAR 2: not assessed

SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.

Questions

current version

GRADE rated

No studies

Included studies

No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 0 · 0%Moderate 1 · 14.3%High 6 · 85.7%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

Current version only

Patient decision aids versus usual care for adults facing treatment or screening decisions

Population: adults considering treatment or screening decisions

CD001431.PUB6 (current) · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Congruence between informed values and choice ‐ all studies Based on the proportion of participants who made a decision that aligned with what was most important to them. Assessed soon after exposure to the decision aid. Patient decision aids vs usual care	RR 1.75 [1.44, 2.13]	21 studies · 9377 participants	Moderate Downgraded: risk of bias, inconsistency, publication bias
Knowledge ‐ all studies Standardized on a scale from 0 (no knowledge) to 100 (perfect knowledge). Assessed soon after exposure to the decision aid. Patient decision aids vs usual care	no estimate extracted	107 studies · 25492 participants	High
Accurate risk perceptions ‐ all studies Based on the accuracy of perceived outcome probabilities according to the percentage of individuals whose judgments corresponded to the scientific evidence about the chances of an outcome for similar people.... Patient decision aids vs usual care	RR 1.94 [1.61, 2.34]	25 studies · 7796 participants	High
Decisional conflict: uninformed subscale ‐ all studies Standardized on a scale from 0 (informed) to 100 (uninformed). Assessed soon after exposure to the decision aid. Patient decision aids vs usual care	no estimate extracted	58 studies · 12104 participants	High
Decisional conflict: unclear about personal values subscale ‐ all studies Standardized on a scale from 0 (clear) to 100 (unclear). Assessed soon after exposure to the decision aid. Patient decision aids vs usual care	no estimate extracted	55 studies · 11880 participants	High
Participation in decision‐making: clinician‐controlled decision‐making ‐ all studies Based on the proportion of participants who indicated a passive role in decision‐making where the decision was primarily made by the clinician. Assessed soon afte... Patient decision aids vs usual care	RR 0.72 [0.59, 0.88]	21 studies · 4348 participants	High
Adverse events: decision regret ‐ all studies Standardized on a scale from 0 (no regret) to 100 (high regret). Assessed weeks to months after the decision is made. Patient decision aids vs usual care	no estimate extracted	22 studies · 3707 participants	High

Comparison

Population: adults considering treatment or screening decisions

CD001431.PUB5 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Knowledge ‐ all studies Standardized on score from 0 (no knowledge) to 100 (perfect knowledge), soon after exposure to the decision aid	no estimate extracted	52 studies · 13316 participants	High
Accurate risk perceptions ‐ all studies Assessed soon after exposure to the decision aid	RR 2.1 [1.66, 2.66]	17 studies · 5096 participants	Moderate Downgraded: risk of bias
Congruence between the chosen option and informed values ‐ all studies Assessed soon after exposure to the decision aid	RR 2.06 [1.46, 2.91]	10 studies · 4626 participants	Low Downgraded: risk of bias
Decisional conflict: uninformed subscale ‐ all studies Standardized on score from 0 (not uninformed) to 100 (uninformed) Assessed soon after exposure to the decision aid	no estimate extracted	27 studies · 5707 participants	High
Decisional conflict: unclear about personal values subscale ‐ all studies Standardized on score from 0 (not unclear) to 100 (unclear) Assessed soon after exposure to the decision aid	no estimate extracted	23 studies · 5068 participants	High
Participation in decision making: clinician‐controlled decision making ‐ all studies Assessed soon after consultation with clinician	RR 0.68 [0.55, 0.83]	16 studies · 3180 participants	Moderate Downgraded: risk of bias
Adverse events	no estimate extracted	NR	No studies

Comparison

Population: adults considering treatment or screening decisions

CD001431.PUB4 · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Knowledge: decision aid versus usual care ‐ all studies standardized on score from 0 (no knowledge) to 100 (perfect knowledge) [soon after exposure to the decision aid]	no estimate extracted	42 studies · 10842 participants	High
Accurate risk perceptions ‐ all studies [soon after exposure to the decision aid]	RR 1.82 [1.52, 2.16]	19 studies · 5868 participants	Moderate Downgraded: risk of bias
Congruence between the chosen option and their values ‐ all studies [soon after exposure to the decision aid]	RR 1.51 [1.17, 1.97]	13 studies · 4670 participants	Low Downgraded: risk of bias
Decisional conflict: decision aid versus usual care ‐ all studies ‐ Uninformed sub‐scale standardized on score from 0 (not uninformed) to 100 (uninformed) [soon after exposure to the decision aid]	no estimate extracted	22 studies · 4343 participants	High
Decisional conflict: decision aid versus usual care ‐ all studies ‐ Unclear values sub‐scale standardized on score from 0 (not unclear) to 100 (unclear) [soon after exposure to the decision aid]	no estimate extracted	18 studies · 3704 participants	High
Participation in decision making: decision aid versus usual care ‐ all studies ‐ Practitioner controlled decision making [soon after consultation with practitioner]	RR 0.66 [0.53, 0.81]	14 studies · 3234 participants	Moderate Downgraded: risk of bias