Overall, the outcomes of patient decision aids have been well documented. The most recent Cochrane Database systematic review showed that patients using decision aids were less conflicted about their choices.15 The study also showed that patients’ preference indecision decreased, participation in the decision-making process improved, and they felt equally or more content with their choices and the overall decision-making process.15 A systematic review by Trevena et al16 showed an increased understanding of health care choices, more accurate expectations, decreased decisional conflict, and lower passive decision-making in patients using these educational supplements.
Today, patient decision aids have been used in various specialties of medicine and surgery. They range from helping patients in their struggles with posttraumatic stress disorder to the management of osteoarthritis.17–28 Several studies point to successful patient-centered care delivery with the use of decision aids. Patients choosing treatments for valve replacement, diabetes, and prostate cancer felt better informed17,18,23 and had increased knowledge17,18,23,26 of their medical options because of decision aid use. Patients found the aids to be useful20,21,24–26 and helpful in increasing shared decision-making.18,20,25 Anxiety and depression decreased for patients making medical decisions.17,18 Parents who required consultation on the difficult topic of prematurity reported reduced decisional conflict when using decision aids.25 Watts et al27 also found that patients who use patient decision aids are more likely to choose evidence-based therapy and have superior outcomes.
Deficiencies in shared decision-making can lead to poor decision quality in the perioperative setting. A study by Ankuda et al30 shows that over one-third of preoperative patients had deficits in their preoperative decision-making. Contributing factors include varying education levels, language barriers, and patient value systems, and shortcomings in the informed consent process (13% of patients).30 Further, poor comprehension stems from patients’ discomfort in the hospital setting and anxiety about the imminent procedure.30 To evaluate the quality, Ankuda et al30 utilized the Donabedian model for analysis (Table 4). In this paper, the structure, process, and outcome of decision-making processes are considered. The structure encompasses the patients’ understanding of the procedure, including risks, benefits, and alternatives. Informed consent is included in this domain. The process is concerned with the actual steps in making a health care decision, such as treatment plans, procedures, and surgeries. Finally, the outcome of the decision and the patient’s comprehension of the information are analyzed.
A paper by Cooper and colleagues further described patient factors that lower decisional quality in the perioperative setting. Nonwhite races, the elderly, and patients with lower educational levels are at risk of low decision quality.31 In addition to the socioeconomic parameters, patients exhibiting denial were at high risk of knowledge deficits in the face of medical decision-making.31 Given time constraints during the perioperative period, clinicians are often limited in their ability to communicate important concepts with patients.32 The aids provide better knowledge of the health care options, leading to better understanding during informed consent. They open the conversation for patients to discuss their situation, preferences, and goals for therapy, while establishing shared decision-making with the patients, their loved ones, and physicians. Patient engagement and shared decision-making are believed to lead to higher decision quality, elevated number of positive surgical outcomes, and less inappropriate procedures.32 Addressing these areas of weakness is key to improving decision quality and use of patient decision aids is pivotal in the fight against health care disparities.
Two anesthesia patient decision aids, Epidural and Spinal Anesthesia and Peripheral Nerve Blocks, were created by the American Society of Anesthesiologists (ASA) Committee on Professional Liability.33,34 Recently, the ASA Committee on Patient Safety and Education created a new decision aid for MAC following the requisite steps in “Concepts for the Development of Anesthesia-Related Patient Decision Aids”14 by (1) creating, (2) vetting, and (3) beta testing the decision aid at Beth Israel Deaconess Medical Center (BIDMC), Boston, MA.35
Shared decision-making between physicians, patients, and their families is essential for patient-centered care. However, implementing the concept in the perioperative setting can be challenging. Studies have shown that patients feel better informed, have better knowledge, and have less anxiety, depression, and decisional conflict after using patient decision aids. Patient education decision aids can support patient-centered care delivery, especially in the field of anesthesia. Further investigations into quality and patient satisfaction endpoints of the newly developed anesthesia patient decision aids are needed to improve decision outcomes globally.
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