Background
Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty.

Objectives
To assess the effects of decision aids for people facing treatment or screening decisions.

Search methods
For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008).

Selection criteria
We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions.

Data collection and analysis
Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:

A) 'choice made' attributes;

B) 'decision-making process' attributes.

Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model.

Main results
This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.

Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies).

A) Criteria involving 'choice made' attributes:

Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13).

B) Criteria involving 'decision-making process' attributes:

Decision aids compared to usual care interventions resulted in:

a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18);

b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); and

c) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18).

Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to be made, or understanding that values affect the choice.

C) Secondary outcomes

Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable.

The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive.

Authors' conclusions
There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.

New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.

/pdf/decision-aids-for-people-facing-health-treatment-or-1j1706q17l.pdf

Decision aids for people facing health treatment or screening decisions

https://in.bgu.ac.il/en/fohs/communityhealth/Family/Documents/DOCTOR-PATIENT%20COMMUNICATION%20A%20REVIEW%20OF.pdf

Doctor-patient communication: a review of the literature.

ContextPhysician gender has been viewed as a possible source of variation in
the interpersonal aspects of medical practice, with speculation that female
physicians facilitate more open and equal exchange and a different therapeutic
milieu from that of male physicians. However, studies in this area are generally
based on small samples, with conflicting results.ObjectiveTo systematically review and quantify the effect of physician gender
on communication during medical visits.Data SourcesOnline database searches of English-language abstracts for the years
1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was
conducted of reprint files and the reference sections of review articles and
other publications.Study SelectionStudies using a communication data source, such as audiotape, videotape,
or direct observation, and large national or regional studies in which physician
report was used to establish length of visit, were identified through bibliographic
and computerized searches. Twenty-three observational studies and 3 large
physician-report studies reported in 29 publications met inclusion criteria
and were rated.Data ExtractionThe Cohen d was computed based on 2 reviewers'
(J.A.H. and Y.A.) independent extraction of quantitative information from
the publications. Study heterogeneity was tested using Q statistics and pooled
effect sizes were computed using the appropriate effects model. The characteristics
of the study populations were also extracted.Data SynthesisFemale physicians engage in significantly more active partnership behaviors,
positive talk, psychosocial counseling, psychosocial question asking, and
emotionally focused talk. There were no gender differences evident in the
amount, quality, or manner of biomedical information giving or social conversation.
Medical visits with female physicians are, on average, 2 minutes (10%) longer
than those with male physicians. Obstetrics and gynecology may present a different
pattern than that of primary care, with male physicians demonstrating higher
levels of emotionally focused talk than their female colleagues.ConclusionsFemale primary care physicians engage in more
communication that can be considered patient centered and have longer
visits than their male colleagues. Limited studies exist outside of
primary care, and gender-related practice patterns in some
subspecialties may differ from those evident in primary
care.

https://jamanetwork.com/journals/jama/articlepdf/195191/jrp10033.pdf

Physician gender effects in medical communication: A meta-analytic review

▪ Abstract Package size, plate shape, lighting, socializing, and variety are only a few of the environmental factors that can influence the consumption volume of food far more than most people realize. Although such environmental factors appear unrelated, they generally influence consumption volume by inhibiting consumption monitoring and by suggesting alternative consumption norms. For researchers, this review suggests that redirecting the focus of investigations to the psychological mechanisms behind consumption will raise the profile and impact of research. For health professionals, this review underscores how small structural changes in personal environments can reduce the unknowing overconsumption of food.

Environmental factors that increase the food intake and consumption volume of unknowing consumers.

The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).

Physicians' characteristics influence patients' adherence to medical treatment: Results from the Medical Outcomes Study.

In the present study, the validity of the Eating Disorder Inventory (EDI) in a Dutch nonclinical female school population was established. The data were analyzed in two ways. In the first analyses, the factorial integrity of the questionnaire, and the internal consistencies of the subscales were not found to be very satisfactory. The data showed an impressive lack of variability. It was suggested by the authors that in a nonclinical population the variability of the EDI data is being suppressed as a result of the fact that, in concordance with the manual, the original 6-point EDI items were transformed into 4-point items. In the second analyses, this item transformation was ejected. The psychometric properties of all EDI subscales in the present study improved. Implications for the use of the untransformed EDI as a screening instrument were discussed.

Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses

Treatment motivation: An attempt for clarification of an ambiguous concept.

Verbal analysis of doctor-patient communication

Tendency toward overeating and restraint as predictors of food consumption

In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule-breaking, and psychopathology was conducted among young Dutch prisoners. Two hundred and twenty-one young adult prisoners (mean age=21.0, range 18-25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1-3 months. As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one-tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. As the incidents reported concerned aggressive and rule-breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self-reported) outcome measures, the results should be interpreted with caution.

Cees P. F. van der Staak

Papers

Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses

Treatment motivation: An attempt for clarification of an ambiguous concept.

Verbal analysis of doctor-patient communication

Tendency toward overeating and restraint as predictors of food consumption

Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners