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