Conceptual Basis of Patient Decision Support Tools
Understanding patient decision support tools (PDSTs) requires first understanding how patients make decisions. This toolkit reviews two frameworks for understanding PDSTs that have been highlighted by implementation researchers in this field.
The Ottawa Decision Support Framework (ODSF)
The ODSF links patient decision support needs with counseling, decision tools, and coaching in order to improve decision making. The Ottawa Hospital Research Institute (OHRI, 2015) notes that the ODSF has been used in the development of over 30 patient decision support tools, as well as provider resources, and evaluation tools. An important feature of the ODSF is the characterization of measurable outcomes within the domains of decision quality, patient actions, and the outcomes for the patient and health system. The OHRI’s framework (figure 1) “applies to participants involved in decision making, including the individual, couple or family, and their health practitioner. The framework asserts that participants’ decisional needs will affect decision quality (informed, values-based choices), which in turn affects actions or behaviour (e.g., delay), health outcomes, emotions (regret, blame), and appropriate use of health services.”
Figure 1: Ottawa Decision Support Framework
Interprofessional Shared Decision Making Model (IP-SDM)
The IP-SDM was developed to emphasize environmental and social factors that contribute to patient decision making, and to highlight the role of the interprofessional team in decision coaching. The IP-SDM has been crucial to expanding decision making outside the patient-practitioner dyad (Figure 2).
Figure 2: IP-SDM Model
Both the ODSF and IP-SDM have informed the creation of hundreds of decision aids and shared decision making tools. Most of these tools present easily understandable information about the burdens, benefits, and harms of various choices while asking patients to prioritize each of these outcomes.
As an example, one shared decision making tool designed to help patients make choices about diabetic medications first asks patients what aspects of the choice they would like to discuss (e.g., how often and by what route a medication is given, whether there is a risk of low blood sugar, how the medication will affect weight, other side effects, how often blood sugar testing will be needed, cost, or how effective is the medication at improving blood sugar control). Using a set of cards (Figure 3) that illustrate the information requested, a patient and provider (or decision coach) can discuss the aspects of greatest import to the patient before jointly identifying the treatment that is most consistent with patient values and preferences.
Figure 3: Decision Aid for Diabetes Treatments