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Background <p>Patient decision aids (PtDAs) provide benefits and risks of options for a specific decision, and help patients clarify their values. This study examined whether the timing of PtDA use—before (pre-consult) or during (in-consult) the clinical encounter—affects patient-clinician communication.</p> Methods <p>We conducted a secondary analysis of 209 randomized controlled trials (RCTs) in the 2024 Cochrane review of PtDAs compared to usual care. Eligible studies measured patient-clinician communication using observer-, patient- or clinician-reported instruments.</p> Results <p>Thirty-six RCTs met inclusion criteria, reporting on communication outcomes: 21 evaluated pre-consult PtDAs and 15 in-consult PtDAs. Pre-consult PtDAs commonly addressed screening and treatment decisions, often using digital formats. In-consult PtDAs focused on treatment and were mostly paper-based. For pre-consult PtDAs, 68.6% of patients discussed the decision with their clinician versus 50.2% in usual care (<i>p</i> &lt; 0.001), though no difference was found for patient-reported SDM-Q-9 scores. In-consult PtDAs significantly improved communication measured by the observer-rated OPTION12 instrument.</p> Conclusions <p>The effects of PtDAs varied by timing and measurement approach, with in-consult PtDAs potentially offering more structured support for shared decision making. No studies directly compared pre- and in-consult PtDAs. Future research should directly compare these approaches and use consistent communication measures.</p>

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Effects of patient decision aids used pre-consult or in-consult on patient-clinician communication - secondary analysis of a systematic review with meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Bettina Mølri Knudsen,
  • Stine Rauff Søndergaard,
  • Meg Carley,
  • Karina Dahl Steffensen,
  • Dawn Stacey

摘要

Background

Patient decision aids (PtDAs) provide benefits and risks of options for a specific decision, and help patients clarify their values. This study examined whether the timing of PtDA use—before (pre-consult) or during (in-consult) the clinical encounter—affects patient-clinician communication.

Methods

We conducted a secondary analysis of 209 randomized controlled trials (RCTs) in the 2024 Cochrane review of PtDAs compared to usual care. Eligible studies measured patient-clinician communication using observer-, patient- or clinician-reported instruments.

Results

Thirty-six RCTs met inclusion criteria, reporting on communication outcomes: 21 evaluated pre-consult PtDAs and 15 in-consult PtDAs. Pre-consult PtDAs commonly addressed screening and treatment decisions, often using digital formats. In-consult PtDAs focused on treatment and were mostly paper-based. For pre-consult PtDAs, 68.6% of patients discussed the decision with their clinician versus 50.2% in usual care (p < 0.001), though no difference was found for patient-reported SDM-Q-9 scores. In-consult PtDAs significantly improved communication measured by the observer-rated OPTION12 instrument.

Conclusions

The effects of PtDAs varied by timing and measurement approach, with in-consult PtDAs potentially offering more structured support for shared decision making. No studies directly compared pre- and in-consult PtDAs. Future research should directly compare these approaches and use consistent communication measures.