The loss of reason in patient decision aid research: do checklists damage the quality of informed choice interventions?

Abstract

Objective: To discuss whether using the International Patient Decision Aids Standards (IPDAS) Collaboration checklist as a gold standard to judge interventions' quality is premature and potentially detrimental to the validity of resources designed to help patients make treatment choices.

Methods: Conceptual review integrating the science behind individuals' decision making with the demands of designing complex, healthcare interventions.

Results: Patient decision aids are promoted as interventions to help professionals engage in shared and/or patient-centred care. The IPDAS domains were informed by experts' opinions of best practice. Decision scientists study how individuals make decisions, what biases their choices and how best to support decisions. There is debate from decision scientists about which component parts are the active ingredients that help people make decisions.

Conclusions: Interventions to help patients make choices have different purposes, component parts and outcomes to those facilitating professional-patient communications. The IPDAS checklist will change to respond to new evidence from the decision sciences.

Practice implications: Adhering uncritically to the IPDAS checklist may reduce service variation but is not sufficient to ensure interventions enable good patient decision making. Developers must be encouraged to reason about the IPDAS checklist to identify those component parts that do (not) meet their intervention's purpose.