Updated review: Decision aids for people facing health treatment or screening decisions

Dawn Stacey and colleagues recently updated this highly cited review. The Plain Language Summary of the updated review is shown below.

Review question

We reviewed the effects of decision aids on people facing health treatment or screening decisions. In this update, we added 18 new studies for a total of 105.


Making a decision about the best treatment or screening option can be hard. People can use decision aids when there is more than one option and neither is clearly better, or when options have benefits and harms that people value differently. Decision aids may be pamphlets, videos, or web-based tools. They state the decision, describe the options, and help people think about the options from a personal view (e.g. how important are possible benefits and harms).

Study characteristics

For research published up to April 2015, there were 105 studies involving 31,043 people. The decision aids focused on 50 different decisions. The common decisions were about: surgery, screening (e.g. prostate cancer, colon cancer, prenatal), genetic testing, and medication treatments (e.g. diabetes, atrial fibrillation).The decision aids were compared to usual care that may have included general information or no intervention. In the 105 studies, 89 evaluated a patient decision aid used by people in preparation for the visit with the clinician, and 16 evaluated its use during the visit with the clinician.

Key results with quality of the evidence

When people use decision aids, they improve their knowledge of the options (high-quality evidence) and feel better informed and more clear about what matters most to them (high-quality evidence). They probably have more accurate expectations of benefits and harms of options (moderate-quality evidence) and probably participate more in decision making (moderate-quality evidence). People who use decision aids may achieve decisions that are consistent with their informed values (evidence is not as strong; more research could change results). People and their clinicians were more likely to talk about the decision when using a decision aid. Decision aids have a variable effect on the option chosen, depending on the choice being considered. Decision aids do not worsen health outcomes, and people using them are not less satisfied. More research is needed to assess if people continue with the option they chose and also to assess what impact decision aids have on healthcare systems.

You can read the review in full on the Cochrane Library.

The authors of this review have also created an international A to Z inventory of patient decision aids.