Decision aids that really promote shared decision making: the pace quickens

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.g7624 (Published 10 February 2015)Cite this as: BMJ 2015;350:g7624

Thomas Agoritsas, research fellow1 2,
Anja Fog Heen, doctoral candidate3 4,
Linn Brandt, doctoral candidate3 4,
Pablo Alonso-Coello, associate researcher 1 5,
Annette Kristiansen, doctoral candidate3 4,
Elie A Akl, associate professor 1 6,
Ignacio Neumann, assistant professor 1 7,
Kari AO Tikkinen, adjunct professor 1 8,
Trudy van der Weijden, professor 9,
Glyn Elwyn, professor10,
Victor M Montori, professor11,
Gordon H Guyatt, distinguished professor1,
Per Olav Vandvik, associate professor 3 4

Correspondence to: T Agoritsas, thomas.agoritsas@gmail.com

Decision aids can help shared decision making, but most have been hard to produce, onerous to update, and are not being used widely. Thomas Agoritsas and colleaguesexplore why and describe a new electronic model that holds promise of being more useful for clinicians and patients to use together at the point of care

Many, perhaps most, important decisions in medicine are not clear cut. Patients and clinicians need to discuss the options using the best available evidence and make informed joint decisions that take account of patients’ context, values, and preferences. But implementing shared decision making is not easy. Doctors need the skills and tools to do it and to build trust; patients need information and support. Patients also need to have a greater role in developing strategies to improve the process.

Access to best evidence is another key ingredient. Until now the production and dissemination of clinical practice guidelines and summaries of evidence has largely been tailored to meet the educational needs of clinicians. They are seldom provided in a format that supports shared decision making. Patients meanwhile, struggle to find reliable and accessible summaries of evidence, although plain language summaries and patient versions of guidelines are being developed.

In this article we highlight the limitations of current decision aids and discuss how the generic production of electronic decision aids designed for use in the clinical encounter, linked directly to trustworthy summaries of evidence from systematic reviews and guidelines, may help in the long march to realising effective shared decision making.