PS2-59 CHOOSING TREATMENTS CONGRUENT WITH VALUES: DO PATIENTS NEED HELP AND DO DECISION AIDS PROVIDE IT? SUB-ANALYSIS OF A SYSTEMATIC REVIEW

Monday, October 19, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS2-59

Sarah Munro, MA, University of British Columbia, Vancouver, BC, Canada, Dawn Stacey, RN, PhD, CON (C), University of Ottawa, Ottawa, ON, Canada, Krystina B. Lewis, RN, MN, CCN(C), University of Ottawa Heart Institute, Ottawa, ON, Canada and Nick Bansback, PhD, University of British Columbia; Centre for Clinical Epidemiology and Evaluation; Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
Purpose: There has been rapid growth in the development of patient decision aids (PtDAs), but there is limited evidence supporting their effectiveness in helping promote decisions that reflect patients’ values. This review focuses on value congruence, a key component of decision quality defined as the match between the chosen option and the features that matter most to the patient. We investigated how well patients make value congruent health decisions with and without PtDAs, and identify issues with its measurement and evaluation.

Method:  This systematic review was conducted as a sub-analysis of randomized controlled trials (RCTs) included in the 2014 Cochrane Review of PtDAs. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Results were reported descriptively. Pooled relative risks (RR) were also calculated where quantitative results were available and all data were analyzed with a random-effects model because of the diverse nature of the studies being combined.

Result:  Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) did not provide clear descriptions of methods. In the control arms of the 11 trials with quantitative results, the mean rate of value congruent decision-making for participants who did not use a PtDA (n=1,844) was 38.2% (range: 12.2%-67%). In the intervention arms of the 11 trials with quantitative results, the mean rate of value congruent decision-making for participants who used a PtDA (n=1,967) was 49.5% (range: 23.1%-76%). Only 4 trials (22%) found a statistically significant difference in value congruent decision-making between groups. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Pooled results of trials that used the MMIC suggest that patients are 48% more likely to make a value congruent decision when exposed to a PtDA (RR 1.48, 95% CI 1.01 to 2.16, n=8).

Conclusion:  Only 16% of RCTs of PtDAs reported value congruence outcomes. These studies suggest patients struggle to make value congruent decisions, but PtDAs can help. A small positive effect was observed, but this may be underestimated due to issues of sample size, definitions, and heterogeneity in measures. Research to standardize value congruence outcomes is a priority such that this important measure can be included in future studies of PtDAs.

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