DO PATIENTS, PROVIDERS, AND THE PUBLIC VALUE SHARED DECISION-MAKING? A SYSTEMATIC REVIEW OF DISCRETE CHOICE EXPERIMENTS

Purpose:  To systematically identify discrete choice experiments (DCEs) which include a shared decision making (SDM) attribute, to determine how SDM has been defined in DCEs, and if, and how, SDM is valued relative to other factors, including health outcomes.

Methods: A systematic review of the literature was undertaken. The search terms were based on previous systematic reviews of DCEs in healthcare, and included the MEDLINE electronic bibliographic database. Title and abstract screening was performed independently and in duplicate to identify DCEs in healthcare, with discrepancies resolved through discussion. All relevant healthcare DCEs were reviewed in full-text to identify those which contained one or more attribute related to shared decision-making (SDM). In order to be eligible, studies needed to include one SDM attribute which varied with respect to level of involvement in decision-making, but could also include additional SDM attributes related to information provision or deliberation. Data extraction was completed in duplicate, and included information related to choice question format, attributes, and levels (including SDM descriptions), experimental design, sample and survey administration, and analysis procedure and statistical tests. SDM attributes were assessed for significance and direction of effect.

Results:  The search produced 24 discrete choice experiments. Most DCEs were generic (unlabeled) with no opt out, and included between 5 and 8 attributes. Experiment designs were predominantly fractional factorial with main effects, aimed for orthogonality, and used a block design. Studies were performed across a range of healthcare contexts, with most sampling frames including patients with some including providers, policy makers, or the public. There was heterogeneity in how SDM was defined, and number of SDM attributes included (range 1 to 4). In total, 6 studies (including 2 BWS) included at least one health outcome attribute. Of all DCEs reporting on significance of SDM attributes (n=21), 32/34 (94%) attributes were statistically significant. All significant attributes favored greater patient involvement in decision-making, greater deliberation, and more information.

Conclusions: SDM attributes were a significant driver of preferences, indicating that it SDM was valued by patients, providers, and the public. Very few studies included health outcomes as an attribute. In cases where SDM requires additional healthcare resources, investments in SDM need to be considered against alternative investments which may generate improved health outcomes.