Quality of Decision Support Tools
While the evidence is clear that decision support tools work to improve important patient decision making quality outcomes, there are important gaps remaining for full adoption by health care professionals. Notably, there are no national standards for decision support tools.
The International Patient Decision Aids Standards (IPDAS), the product of a worldwide collaboration of researchers, practitioners, and stakeholders, first addressed quality standards for decision aids in 2003 and set the original 12 core quality dimensions in 2006. There are now 10 standards: information, probabilities, values, guidance, development, evidence, disclosure, plain language, evaluation, and testing.
Over the past decade through an iterative process the IPDAS collaboration has adapted and honed the list in an effort to create minimum standards. Recent work proposes three criteria domains: qualifying, certification, and quality. A tool must meet all qualifying criteria to be considered a decision aid and then pass a threshold to become a certified decision aid.
An aid that qualifies must include a description of the condition or problem, explicit statement of the decision under consideration, description of the options available, description of both positive and negative features, and a description of what it is like to experience the consequences (IPDAS Steering Committee, 2013; Joseph-Williams et al., 2013) (Volk, Llewellyn-Thomas, Stacey, & Elwyn, 2013). There are limits to this process, notably that the certification criteria does not assess the quality of the evidence informing the aid.
In 2013, the journal Medical Informatics & Decision Making published a supplemental issue dedicated to IPDAS with 13 manuscripts covering fundamental research issues in this field with all articles available as open access to the public.
While decision support tools can apply to the IPDAS collaborative for assessment, these criteria have not been formally adopted or fully implemented here in the United States.
However, states are looking at ways to certify decision aids and promote shared decision making. In 2007, the state of Washington passed legislation authorizing a demonstration project on shared decision making. In 2012, legislation authorized the Medical Director of the Washington Health Care Authority (HCA) to certify decision aids to be used across the state. The Washington HCA is currently working with IPDAS to create a certification process (D. Lessler, personal communication, July, 15, 2015). Decision support tool certification is part of a statewide effort to promote shared decision making, including the passage of legislation allowing the use of certified decision aids to qualify as informed consent (Washington State Health Care Authority, 2015; Washington State Legislature, 2007).
Other states with on-going projects include Maine, Minnesota, and Vermont (Shafir & Rosenthal, 2012). The Minnesota Shared Decision-Making Collaborative, a multi-stakeholder group including experts from the Mayo Clinic, University of Minnesota, health plans, and the Department of Health produced a useful website of resources, available at msdmc.org. This also includes an implementation roadmap for shared decision making.
Currently, the Ottawa Hospital Research Institute (OHRI) compiles a database of decision support tools quality assessed using a 25-item checklist modified from the IPDAS criteria. The domains include content, development process and effectiveness. Topics range from acne to weight control and include many common treatment and screening decisions. The OHRI requires the tool be publicly available to be listed in their database. Most tools are web-based but can be printed for take-home use as well. This database is the most thorough source of information about publicly available decision aids.