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The state-of-the-art knowledge about the effectiveness of PtDAs to support people
in making medical treatment or screening decisions is promising: an accumulating
amount of research, including over 100 PtDAs studies across a variety of medical
treatment and screening decisions, has showed that patient decision aids have been
effective in improving people’s knowledge, feelings of being well-informed and clarity
about their personal values. The evidence is less clear with regard to other outcomes, but
it appears likely that people who have been exposed to PtDAs also have more accurate
knowledge of the benefits and harms associated with medical options and have been
more actively involved in the decision making process. Also, there is some evidence
suggesting that PtDAs may help people to make choices that are congruent with their
personal values and preferences, but more research is needed in this area. PtDAs do not
have adverse effects on health outcomes or patient satisfaction. More research is needed
to determine if PtDAs help people receive and adhere to their chosen option [16] and if
this results in, for example, better well-being and quality of life.
Even though the available evidence shows that the use of PtDAs has the potential
to help people make better health decisions (in terms of better matching their values and
preferences), more fine-grained understanding of the underlying processes is limited.
Most studies so far have compared PtDAs to usual care rather than using a study design
suitable to identify “active ingredients”. This limits the extent to which evidence-based
guidance for designing effective PtDAs can be formulated. A theory-based approach can
help to further the field. In the past, VCMs for example have often been designed without
clearly being rooted in theory [25]. This may have hampered VCM effectiveness and
complicated transparent and coherent, systematic design and evaluation. Where theory
has been used, debate followed about the appropriateness of theory for the design of
VCMs [e.g., 20,26]. Similarly, there is a gap in the evidence base for risk communication
in the context of PtDAs. For example, it is still unclear how we can tailor risk
communication in the context of eHealth and interactive tools to individual needs and
abilities. What are optimal risk communication formats for vulnerable groups, including
those with lower health literacy, numeracy and/or graph literacy? Rooting the design of
PtDAs (including VCMs and risk communication) in theory and providing a clear
rationale on how the theory has informed PtDAs design, enables targeted tests of the
underlying mechanisms and may ultimately help to uncover the “active ingredients” of
PtDAs. Addressing this gap will require systematic testing of different information
formats within the same PtDA.
2.2. Challenges and opportunities of the boosting framework in the context of health
decision support design and evaluation.
Application of the boosting framework to personal health choices and the SDM
process unveils new and promising horizons for future research and could inform the
design and evaluation of health informatics interventions aimed at facilitating SDM,
including PtDAs. In this section, we elaborate on the challenges and opportunities of the
boosting framework in the context of health decision support design and evaluation.
The main opportunities of using the boosting framework in this context are the
guidance it can provide to design and test health informatics interventions that fit the way
the human mind is wired, so that the interventions are likely to be more user-friendly,
useful and effective–and therefore also more likely to be implemented and used
sustainably. Implementation of PtDAs, and more broadly speaking of SDM, in everyday
healthcare has so far been a major challenge [e.g., 2]. In a recent study [27] investigating
M.deVriesetal. /FosteringSharedDecisionMakingwithHealth Informatics Interventions 117
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik