Peering into the black box: a meta-analysis of how clinicians use decision aids during clinical encounters

Implement Sci. 2014 Feb 22;9:26. doi: 10.1186/1748-5908-9-26.

Abstract

Objective: To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes.

Methods: Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions.

Results: Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD = 23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p = 0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter.

Conclusion: Clinicians' fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Decision Support Systems, Clinical / statistics & numerical data*
  • Female
  • Health Personnel*
  • Humans
  • Male
  • Middle Aged
  • Patient Participation*
  • Patient Satisfaction
  • Randomized Controlled Trials as Topic
  • Sex Factors
  • Socioeconomic Factors