Benefits of decision aids uncertain

DECISION aids are a hit with patients but an expert says the jury is out on whether they actually improve clinical outcomes.

Speaking at the recent National Medicines Symposium in Melbourne, Professor Victor Montori of the Mayo Clinic in the US, argued that decision aids could increase patient involvement and influence their treatment choices.

They also improved patients’ understanding of risk and increased trust in their GP, his own research showed.

But despite the potential benefits, a 2009 Cochrane review of 55 studies gave an inconclusive verdict.

“All sorts of interesting aspects improve but there is no change in patient satisfaction or health outcomes, and there is no consistent effect on cost or on the actual direction of the decisions,” said Professor Montori.

“Our policy makers will not endorse the use of these interventions if there is no efficacy on these parameters. If there’s something for diabetes that does not improve sugar control, is it worth implementing in practice just because it helps patients choose their poison better?”

Professor Montori has published widely on decision aids in general practice. One tool comprises flash cards that present statistical data in simple pictorial form to help patients with type 2 diabetes choose their medications.

Despite the equivocal evidence, doctors could still adopt the principles of better communication, he added. 

“Here is some language we can begin to use: there are options – including doing nothing – and I’m happy to implement anything you’re okay with. There is no trap and no wrong choice.”