Magnolia Cardona-Morrell1, Gustavo Benfatti-Olivato2, Jesse Jansen3, Robin M Turner4, Diana Fajardo-Pulido4, Ken Hillman5. 1. South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia. Electronic address: m.cardonamorrell@unsw.edu.au. 2. Faculty of Medicine, The University of New South Wales, Australia and Botucatu Medical School, Sao Paulo State University, Botucatu, Brazil. 3. Sydney School of Public Health and Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, Australia. 4. School of Public Health and Community Medicine, The University of New South Wales, Australia. 5. South Western Sydney Clinical School and Ingham Institute for Applied Medical Research, The University of New South Wales, Sydney, Australia; Intensive Care Unit, Liverpool Hospital, Sydney, Australia.
Abstract
OBJECTIVE: To describe the range of decision aids (DAs) available to enable informed choice for older patients at the end of life and assess their effectiveness or acceptability. METHODS: Search strategy covered PubMed, Scopus, Ovid MEDLINE, EMBASE, EBM Reviews, CINAHL and PsycInfo between 1995 and 2015. The quality criteria framework endorsed by the International Patient Decision Aids Standards (IPDAS) was used to assess usefulness. RESULTS: Seventeen DA interventions for patients, their surrogates or health professionals were included. Half the DAs were designed for self-administration and few described use of facilitators for decision-making. TREATMENT: options and associated harms and benefits, and patient preferences were most commonly included. Patient values, treatment goals, numeric disease-specific prognostic information and financial implications of decisions were generally not covered. DAs at the end of life are generally acceptable by users, and appear to increase knowledge and reduce decisional conflict but this effectiveness is mainly based on low-level evidence. CONCLUSIONS: Continuing evaluation of DAs in routine practice to support advance care planning is worth exploring further. In particular, this would be useful for conditions such as cancer, or situations such as major surgery where prognostic data is known, or in dementia where concordance on primary goals of care between surrogates and the treating team can be improved. PRACTICE IMPLICATIONS: Given the sensitivities of end-of-life, self-administered DAs are inappropriate in this context and genuine informed decision-making cannot happen while those gaps in the instruments remain.
OBJECTIVE: To describe the range of decision aids (DAs) available to enable informed choice for older patients at the end of life and assess their effectiveness or acceptability. METHODS: Search strategy covered PubMed, Scopus, Ovid MEDLINE, EMBASE, EBM Reviews, CINAHL and PsycInfo between 1995 and 2015. The quality criteria framework endorsed by the International Patient Decision Aids Standards (IPDAS) was used to assess usefulness. RESULTS: Seventeen DA interventions for patients, their surrogates or health professionals were included. Half the DAs were designed for self-administration and few described use of facilitators for decision-making. TREATMENT: options and associated harms and benefits, and patient preferences were most commonly included. Patient values, treatment goals, numeric disease-specific prognostic information and financial implications of decisions were generally not covered. DAs at the end of life are generally acceptable by users, and appear to increase knowledge and reduce decisional conflict but this effectiveness is mainly based on low-level evidence. CONCLUSIONS: Continuing evaluation of DAs in routine practice to support advance care planning is worth exploring further. In particular, this would be useful for conditions such as cancer, or situations such as major surgery where prognostic data is known, or in dementia where concordance on primary goals of care between surrogates and the treating team can be improved. PRACTICE IMPLICATIONS: Given the sensitivities of end-of-life, self-administered DAs are inappropriate in this context and genuine informed decision-making cannot happen while those gaps in the instruments remain.