Patient Decision Aids Improve Patient Safety and Reduce Medical Liability Risk

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]

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Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration

Medical Decision Making ◽

10.1177/0272989x211014163 ◽

2021 ◽

pp. 0272989X2110141

Author(s):

Holly O. Witteman ◽

Kristin G. Maki ◽

Gratianne Vaisson ◽

Jeanette Finderup ◽

Krystina B. Lewis ◽

...

Keyword(s):

Decision Aid ◽

Decision Aids ◽

Rapid Development ◽

User Involvement ◽

User Centered Design ◽

Patient Decision Aid ◽

Patient Decision Aids ◽

Patient Decision ◽

Development Processes ◽

Systematic Development

Background The 2013 update of the evidence informing the quality dimensions behind the International Patient Decision Aid Standards (IPDAS) offered a model process for developers of patient decision aids. Objective To summarize and update the evidence used to inform the systematic development of patient decision aids from the IPDAS Collaboration. Methods To provide further details about design and development methods, we summarized findings from a subgroup ( n = 283 patient decision aid projects) in a recent systematic review of user involvement by Vaisson et al. Using a new measure of user-centeredness (UCD-11), we then rated the degree of user-centeredness reported in 66 articles describing patient decision aid development and citing the 2013 IPDAS update on systematic development. We contacted the 66 articles’ authors to request their self-reports of UCD-11 items. Results The 283 development processes varied substantially from minimal iteration cycles to more complex processes, with multiple iterations, needs assessments, and extensive involvement of end users. We summarized minimal, medium, and maximal processes from the data. Authors of 54 of 66 articles (82%) provided self-reported UCD-11 ratings. Self-reported scores were significantly higher than reviewer ratings (reviewers: mean [SD] = 6.45 [3.10]; authors: mean [SD] = 9.62 [1.16], P < 0.001). Conclusions Decision aid developers have embraced principles of user-centered design in the development of patient decision aids while also underreporting aspects of user involvement in publications about their tools. Templates may reduce the need for extensive development, and new approaches for rapid development of aids have been proposed when a more detailed approach is not feasible. We provide empirically derived benchmark processes and a reporting checklist to support developers in more fully describing their development processes. [Box: see text]

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Effectiveness of patient decision aids in women considering psychotropic medication use during pregnancy: a literature review

Archives of Women s Mental Health ◽

10.1007/s00737-021-01118-3 ◽

2021 ◽

Author(s):

Lucy C. Broughton ◽

Natalie J. Medlicott ◽

Alesha J. Smith

Keyword(s):

Literature Review ◽

Psychotropic Medication ◽

Decision Aids ◽

Medication Use ◽

Patient Decision Aids ◽

Patient Decision

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Erratum to: Kidney Disease Pathways, Options and Decisions (KD-POD): An Environmental Scan of International Patient Decision Aids (PtDA)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa315 ◽

2021 ◽

Author(s):

Anna E Winterbottom ◽

Andrew Mooney ◽

Lynne Russon ◽

Vicki Hipkiss ◽

Lucy Ziegler ◽

...

Keyword(s):

Kidney Disease ◽

Decision Aids ◽

Patient Decision Aids ◽

Environmental Scan ◽

Patient Decision ◽

Disease Pathways

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Writing’s on the wall: improving the WHO Surgical Safety Checklist

BMJ Open Quality ◽

10.1136/bmjoq-2020-001086 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001086

Author(s):

Claire Cushley ◽

Tom Knight ◽

Helen Murray ◽

Lawrence Kidd

Keyword(s):

Patient Safety ◽

Online Survey ◽

Improve Patient Safety ◽

Surgical Safety Checklist ◽

Surgical Safety ◽

Time Out ◽

Mandatory Requirement ◽

Who Checklist ◽

Improve Patient ◽

Theatre Team

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

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