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

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; Tamara Cadet; Anik Giguere; Ashley J Housten; Aisha Langford; Kirsten McCaffery; Marie-Anne Durand

doi:10.1177/0272989X211020317

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

Med Decis Making. 2021 Oct;41(7):870-896. doi: 10.1177/0272989X211020317. Epub 2021 Jun 21.

Authors

Renata W Yen¹, Jenna Smith², Jaclyn Engel¹, Danielle Marie Muscat², Sian K Smith³, Julien Mancini⁴, Lilisbeth Perestelo-Pérez⁵, Glyn Elwyn¹, A James O'Malley^{1

6}, JoAnna K Leyenaar^{1

7}, Olivia Mac², Tamara Cadet^{8

9}, Anik Giguere¹⁰, Ashley J Housten¹¹, Aisha Langford¹², Kirsten McCaffery², Marie-Anne Durand^{1

13}

Affiliations

¹ The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
² Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ University of Bath, School of Management, Bath, Somerset, UK.
⁴ Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d'Azu, France.
⁵ Evaluation Unit (SESCS), Canary Islands Health Service (SCS), REDISSEC, Tenerife, Spain.
⁶ Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA.
⁷ Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
⁸ School of Social Work, Simmons University, Boston, MA, USA.
⁹ Harvard School of Dental Medicine, Boston, MA, USA.
¹⁰ Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada.
¹¹ Washington University School of Medicine, St Louis, MO, USA.
¹² 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.
¹³ 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 [I² = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I² = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I² = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I² = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I² = 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.[Box: see text].

Keywords: health disparities; health literacy; patient decision aids; patient-provider communication; shared decision making.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Communication
Decision Making, Shared
Decision Support Techniques
Humans
Patient Participation*
Vulnerable Populations*

Abstract

Publication types

MeSH terms

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