Elwyn G, O'Connor A, Stacey D, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ.333:417

Department of General Practice, Centre for Health Sciences Research, Cardiff University, Cardiff CF14 4YS.
BMJ (online) (Impact Factor: 17.45). 09/2006; 333(7565):417. DOI: 10.1136/bmj.38926.629329.AE
Source: PubMed


To develop a set of quality criteria for patient decision support technologies (decision aids).
Two stage web based Delphi process using online rating process to enable international collaboration.
Individuals from four stakeholder groups (researchers, practitioners, patients, policy makers) representing 14 countries reviewed evidence summaries and rated the importance of 80 criteria in 12 quality domains on a 1 to 9 scale. Second round participants received feedback from the first round and repeated their assessment of the 80 criteria plus three new ones.
Aggregate ratings for each criterion calculated using medians weighted to compensate for different numbers in stakeholder groups; criteria rated between 7 and 9 were retained.
212 nominated people were invited to participate. Of those invited, 122 participated in the first round (77 researchers, 21 patients, 10 practitioners, 14 policy makers); 104/122 (85%) participated in the second round. 74 of 83 criteria were retained in the following domains: systematic development process (9/9 criteria); providing information about options (13/13); presenting probabilities (11/13); clarifying and expressing values (3/3); using patient stories (2/5); guiding/coaching (3/5); disclosing conflicts of interest (5/5); providing internet access (6/6); balanced presentation of options (3/3); using plain language (4/6); basing information on up to date evidence (7/7); and establishing effectiveness (8/8).
Criteria were given the highest ratings where evidence existed, and these were retained. Gaps in research were highlighted. Developers, users, and purchasers of patient decision aids now have a checklist for appraising quality. An instrument for measuring quality of decision aids is being developed.

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Available from: Margaret Holmes-Rovner
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    • "Our DAs provide neutral information on diagnostic self-testing in general and on self-testing for cholesterol or diabetes specifically. The DAs were based on clinical practice guidelines, previous research on self-testing [2, 4, 11–14], the International Patient Decision Aid Standard (IPDAS) [15, 16], and the Health Belief Model (HBM) [17, 18]. "
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    ABSTRACT: Diagnostic self-tests are becoming increasingly available. Since the pros and cons of self-testing are unclear and neutral information on self-testing is lacking, two decision aids (DAs) on self-testing for cholesterol and diabetes were developed to support consumers in making an informed choice that is in line with their personal values. We aimed to evaluate the effect of the DAs on the intention to self-test for cholesterol or diabetes, as well as socio-cognitive determinants of that intention.
    Full-text · Article · Sep 2014 · BMC Public Health
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    • "PtDAs provide facts about the condition, options, and attributes such as outcomes and probabilities for each option; a value clarification task that helps patients evaluate which attributes matter most to them; and a guide in the steps of deliberation and communication required for the informed patient to reach their goal – concordance between what matters most to them and their chosen option [7]. An updated Cochrane systematic review found that, among 115 studies involving 34,444 participants, PtDA increase patients’ knowledge about treatment options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values [1]. "
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    ABSTRACT: Background Patient decision aids (PtDA) are developed to facilitate informed, value-based decisions about health. Research suggests that even when informed with necessary evidence and information, cognitive errors can prevent patients from choosing the option that is most congruent with their own values. We sought to utilize principles of behavioural economics to develop a computer application that presents information from conventional decision aids in a way that reduces these errors, subsequently promoting higher quality decisions. Method The Dynamic Computer Interactive Decision Application (DCIDA) was developed to target four common errors that can impede quality decision making with PtDAs: unstable values, order effects, overweighting of rare events, and information overload. Healthy volunteers were recruited to an interview to use three PtDAs converted to the DCIDA on a computer equipped with an eye tracker. Participants were first used a conventional PtDA, and then subsequently used the DCIDA version. User testing was assessed based on whether respondents found the software both usable: evaluated using a) eye-tracking, b) the system usability scale, and c) user verbal responses from a ‘think aloud’ protocol; and useful: evaluated using a) eye-tracking, b) whether preferences for options were changed, and c) and the decisional conflict scale. Results Of the 20 participants recruited to the study, 11 were male (55%), the mean age was 35, 18 had at least a high school education (90%), and 8 (40%) had a college or university degree. Eye-tracking results, alongside a mean system usability scale score of 73 (range 68–85), indicated a reasonable degree of usability for the DCIDA. The think aloud study suggested areas for further improvement. The DCIDA also appeared to be useful to participants wherein subjects focused more on the features of the decision that were most important to them (21% increase in time spent focusing on the most important feature). Seven subjects (25%) changed their preferred option when using DCIDA. Conclusion Preliminary results suggest that DCIDA has potential to improve the quality of patient decision-making. Next steps include larger studies to test individual components of DCIDA and feasibility testing with patients making real decisions.
    Full-text · Article · Aug 2014 · BMC Medical Informatics and Decision Making
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    • "The ‘relevant’ domains (from the analysis in objective one) will be presented to the team. After group discussion, team members will be asked to prioritize the domains on a nine-point scale [37,38]. We will regard domains with an overall rating of seven to nine (without disagreement) as ‘high priority’ for our intervention [38]. "
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    ABSTRACT: Background A shortage of transplantable organs is a global problem. There are two types of organ donation: living and deceased. Deceased organ donation can occur following neurological determination of death (NDD) or cardiocirculatory death. Donation after cardiocirculatory death (DCD) accounts for the largest increments in deceased organ donation worldwide. Variations in the use of DCD exist, however, within Canada and worldwide. Reasons for these discrepancies are largely unknown. The purpose of this study is to develop, implement, and evaluate a theory-based knowledge translation intervention to provide practical guidance about how to increase the numbers of DCD organ donors without reducing the numbers of standard NDD donors. Methods We will use a mixed method three-step approach. In step one, we will conduct semi-structured interviews, informed by the Theoretical Domains Framework, to identify and describe stakeholders’ beliefs and attitudes about DCD and their perceptions of the multi-level factors that influence DCD. We will identify: determinants of the evidence-practice gap; specific behavioural changes and/or process changes needed to increase DCD; specific group(s) of clinicians or organizations (e.g., provincial donor organizations) in need of behaviour change; and specific targets for interventions. In step two, using the principles of intervention mapping, we will develop a theory-based knowledge translation intervention that encompasses behavior change techniques to overcome the identified barriers and enhance the enablers to DCD. In step three, we will roll out the intervention in hospitals across the 10 Canadian provinces and evaluate its effectiveness using a multiple interrupted time series design. Discussion We will adopt a behavioural approach to define and test novel, theory-based, and ethically-acceptable knowledge translation strategies to increase the numbers of available DCD organ donors in Canada. If successful, this study will ultimately lead to more transplantations, reducing patient morbidity and mortality at a population-level.
    Full-text · Article · Jun 2014 · Implementation Science
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