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Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.

Publication ,  Journal Article
Austin, CA; Mohottige, D; Sudore, RL; Smith, AK; Hanson, LC
Published in: JAMA Intern Med
July 2015

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.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 2015

Volume

175

Issue

7

Start / End Page

1213 / 1221

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Decision Making
  • Critical Illness
  • Catastrophic Illness
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1113 Opthalmology and Optometry
  • 1103 Clinical Sciences
 

Citation

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Austin, C. A., Mohottige, D., Sudore, R. L., Smith, A. K., & Hanson, L. C. (2015). Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review. JAMA Intern Med, 175(7), 1213–1221. https://doi.org/10.1001/jamainternmed.2015.1679
Austin, C Adrian, Dinushika Mohottige, Rebecca L. Sudore, Alexander K. Smith, and Laura C. Hanson. “Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.JAMA Intern Med 175, no. 7 (July 2015): 1213–21. https://doi.org/10.1001/jamainternmed.2015.1679.
Austin CA, Mohottige D, Sudore RL, Smith AK, Hanson LC. Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review. JAMA Intern Med. 2015 Jul;175(7):1213–21.
Austin, C. Adrian, et al. “Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.JAMA Intern Med, vol. 175, no. 7, July 2015, pp. 1213–21. Pubmed, doi:10.1001/jamainternmed.2015.1679.
Austin CA, Mohottige D, Sudore RL, Smith AK, Hanson LC. Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review. JAMA Intern Med. 2015 Jul;175(7):1213–1221.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 2015

Volume

175

Issue

7

Start / End Page

1213 / 1221

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Decision Making
  • Critical Illness
  • Catastrophic Illness
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1113 Opthalmology and Optometry
  • 1103 Clinical Sciences