C Adrian Austin1, Dinushika Mohottige2, Rebecca L Sudore3, Alexander K Smith3, Laura C Hanson4. 1. Center for Aging and Health, Division of Geriatrics, University of North Carolina, Chapel Hill. 2. Department of Medicine, Duke University, Durham, North Carolina. 3. Division of Geriatrics, Department of Medicine, University of California, San Francisco4San Francisco Veterans Affairs Medical Center, San Francisco, California. 4. Center for Aging and Health, Division of Geriatrics, University of North Carolina, Chapel Hill5Palliative Care Program, University of North Carolina, Chapel Hill.
Abstract
IMPORTANCE: Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population. OBJECTIVE: To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making in serious illness, thereby (1) identifying tools relevant to the treatment decisions of seriously ill patients and their caregivers, (2) evaluating the quality of evidence for these tools, and (3) summarizing their effect on outcomes and accessibility for clinicians. EVIDENCE REVIEW: We searched PubMed, CINAHL, and PsychInfo from January 1, 1995, through October 31, 2014, and identified additional studies from reference lists and other systematic reviews. Clinical trials with random or nonrandom controls were included if they tested print, video, or web-based tools for advance care planning (ACP) or decision aids for serious illness. We extracted data on the study population, design, results, and risk for bias using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Each tool was evaluated for its effect on patient outcomes and accessibility. FINDINGS: Seventeen randomized clinical trials tested decision tools in serious illness. Nearly all the trials were of moderate or high quality and showed that decision tools improve patient knowledge and awareness of treatment choices. The available tools address ACP, palliative care and goals of care communication, feeding options in dementia, lung transplant in cystic fibrosis, and truth telling in terminal cancer. Five randomized clinical trials provided further evidence that decision tools improve ACP documentation, clinical decisions, and treatment received. CONCLUSIONS AND RELEVANCE: Clinicians can access and use evidence-based tools to engage seriously ill patients in shared decision making. This field of research is in an early stage; future research is needed to develop novel decision aids for other serious diagnoses and key decisions. Health care delivery organizations should prioritize the use of currently available tools that are evidence based and effective.
IMPORTANCE: Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population. OBJECTIVE: To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making in serious illness, thereby (1) identifying tools relevant to the treatment decisions of seriously ill patients and their caregivers, (2) evaluating the quality of evidence for these tools, and (3) summarizing their effect on outcomes and accessibility for clinicians. EVIDENCE REVIEW: We searched PubMed, CINAHL, and PsychInfo from January 1, 1995, through October 31, 2014, and identified additional studies from reference lists and other systematic reviews. Clinical trials with random or nonrandom controls were included if they tested print, video, or web-based tools for advance care planning (ACP) or decision aids for serious illness. We extracted data on the study population, design, results, and risk for bias using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Each tool was evaluated for its effect on patient outcomes and accessibility. FINDINGS: Seventeen randomized clinical trials tested decision tools in serious illness. Nearly all the trials were of moderate or high quality and showed that decision tools improve patient knowledge and awareness of treatment choices. The available tools address ACP, palliative care and goals of care communication, feeding options in dementia, lung transplant in cystic fibrosis, and truth telling in terminal cancer. Five randomized clinical trials provided further evidence that decision tools improve ACP documentation, clinical decisions, and treatment received. CONCLUSIONS AND RELEVANCE: Clinicians can access and use evidence-based tools to engage seriously ill patients in shared decision making. This field of research is in an early stage; future research is needed to develop novel decision aids for other serious diagnoses and key decisions. Health care delivery organizations should prioritize the use of currently available tools that are evidence based and effective.
Authors: Angelo E Volandes; Gary H Brandeis; Aretha Delight Davis; Michael K Paasche-Orlow; Muriel R Gillick; Yuchiao Chang; Elizabeth S Walker-Corkery; Eileen Mann; Susan L Mitchell Journal: J Palliat Med Date: 2012-05-04 Impact factor: 2.947
Authors: Angelo E Volandes; Laurie Anne Ferguson; Aretha D Davis; Nathan C Hull; Michael J Green; Yuchiao Chang; Kristy Deep; Michael K Paasche-Orlow Journal: J Palliat Med Date: 2011-01-21 Impact factor: 2.947
Authors: Laura C Hanson; Timothy S Carey; Anthony J Caprio; Tae Joon Lee; Mary Ersek; Joanne Garrett; Anne Jackman; Robin Gilliam; Kathryn Wessell; Susan L Mitchell Journal: J Am Geriatr Soc Date: 2011-09-15 Impact factor: 5.562
Authors: Michael D. Brundage; Deb Feldman-Stewart; Peter Dixon; Richard Gregg; Youssef Youssef; Diane Davies; William J. MacKillop Journal: Health Expect Date: 2000-03 Impact factor: 3.377
Authors: N B Leighl; F A Shepherd; D Zawisza; R L Burkes; R Feld; J Waldron; A Sun; D Payne; A Bezjak; M H N Tattersall Journal: Br J Cancer Date: 2008-05-27 Impact factor: 7.640
Authors: Michael J Green; Lauren J Van Scoy; Andrew J Foy; Renee R Stewart; Ramya Sampath; Jane R Schubart; Erik B Lehman; Anne E F Dimmock; Ashley M Bucher; Lisa S Lehmann; Alyssa F Harlow; Chengwu Yang; Benjamin H Levi Journal: Am J Hosp Palliat Care Date: 2017-11-29 Impact factor: 2.500
Authors: Laura C Hanson; Sheryl Zimmerman; Mi-Kyung Song; Feng-Chang Lin; Cherie Rosemond; Timothy S Carey; Susan L Mitchell Journal: JAMA Intern Med Date: 2017-01-01 Impact factor: 21.873
Authors: Hillary D Lum; Rebecca L Sudore; Daniel D Matlock; Elizabeth Juarez-Colunga; Jacqueline Jones; Molly Nowels; Robert S Schwartz; Jean S Kutner; Cari R Levy Journal: J Am Board Fam Med Date: 2017 Jul-Aug Impact factor: 2.657
Authors: Jane R Schubart; Jean M Reading; Janice Penrod; Renee R Stewart; Ramya Sampath; Lisa S Lehmann; Benjamin H Levi; Michael J Green Journal: Am J Hosp Palliat Care Date: 2018-09 Impact factor: 2.500