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Background: The increase in elective surgeries and varied postoperative patient outcomes has boosted the use of patient decision support interventions (PDSIs). However, evidence on the effectiveness of PDSIs are not updated. This systematic review aims to summarize the effects of PDSIs for surgical candidates considering elective surgeries and to identify their moderators with an emphasis on the type of targeted surgery. Design: Systematic review and meta-analysis. Methods: We searched eight electronic databases for randomized controlled trials evaluating PDSIs among elective surgical candidates. We documented the effects on invasive treatment choice, decision-making-related outcomes, patient-reported outcomes, and healthcare resource use. The Cochrane Risk of Bias Tool version 2 and Grading of Recommendations, Assessment, Development, and Evaluations were adopted to rate the risk of bias of individual trials and certainty of evidence, respectively. STATA 16 software was used to conduct the meta-analysis. Results: Fifty-eight trials comprising 14 981 adults from 11 countries were included. Overall, PDSIs had no effect on invasive treatment choice (risk ratio = 0.97; 95% CI: 0.90, 1.04), consultation time (mean difference = 0.04 min; 95% CI: -0.17, 0.24), or patient-reported outcomes, but had a beneficial effect on decisional conflict (Hedges' g = - 0.29; 95% CI: - 0.41, - 0.16), disease and treatment knowledge (Hedges' g = 0.32; 95% CI: 0.15, 0.49), decision-making preparedness (Hedges' g = 0.22; 95% CI: 0.09, 0.34), and decision quality (risk ratio = 1.98; 95% CI: 1.15, 3.39). Treatment choice varied with surgery type and self-guided PDSIs had a greater effect on disease and treatment knowledge enhancement than clinician-delivered PDSIs. Conclusions: This review has demonstrated that PDSIs targeting individuals considering elective surgeries had benefited their decision-making by reducing decisional conflict and increasing disease and treatment knowledge, decision-making preparedness, and decision quality. These findings may be used to guide the development and evaluation of new PDSIs for elective surgical care. [ABSTRACT FROM AUTHOR]

There are different stated preference (SP) approaches, including discrete choice experiments (DCEs). DCEs are a popular SP approach, but in some settings, alternative ways of framing survey questions may be more appropriate. The Health Economic Modelling Of Alternative Blood Donation Strategies (HEMO) study required choice tasks to be framed so that the study could estimate the effect of attribute levels on the frequency of a behavior—in this case, blood donation. SP questions were formulated to require ordered categorical responses from a single profile of attribute levels. However, it is unknown whether this way of framing SP questions leads to estimates of marginal rates of substitution (MRS) that are different from traditional DCE choices between 2 alternative profiles. The aim of this article is to compare estimates of relative preferences from SP questions requiring ordered categorical versus discrete choice responses. We compared relative preferences elicited from the 2 approaches for a common set of attributes and levels, formulated as choice tasks for 8,933 whole-blood donors. We found that the 2 forms of survey questions provided similar MRSs estimates. For example, respondents were willing to trade off only a small increase in travel time to receive a health report, irrespective of whether the choice given was binary (DCE response; approximately 3 min) or from an ordered category (about 8 min). The finding that any differences in the estimated MRSs are not of substantive importance offers some reassurance for policy makers in that estimates of relative preference may be robust to alternative ways of framing the survey questions. These findings can encourage future studies to frame choice tasks that align with the study’s objective. [ABSTRACT FROM AUTHOR]

Rationale: Total knee arthroplasty is a common surgical procedure but not appropriate for all patients with knee osteoarthritis. Patient decision aids (PtDAs) can promote shared decision making and enhance understanding and expectations of procedures among patients, resulting in better discussions between patients and healthcare providers about whether total knee arthroplasty is the most appropriate option. Aims and Objectives: Evaluate impact of an individualised PtDA for osteoarthritis patients considering total knee arthroplasty 1 year after baseline assessment. Methods: Prospective, randomised controlled trial comparing an intervention arm (IA) and routine care arm (RCA). The IA included an online individualised patient reported outcome measures (PROMs) based PtDA and one‐page summary report for the surgeon. We report secondary outcomes from the final assessment: patient expectations, decisional regret, patient satisfaction with outcomes of knee replacement, health‐related quality‐of‐life (HRQOL) and depression. We report changes in HRQOL between baseline and final assessments, study arms, and surgical versus non‐surgical patients. Descriptive statistics were used to describe participant characteristics and continuous variables. Dichotomous outcomes (expectations, decisional regret, satisfaction) were analyzed using logistic regression and continuous outcomes (HRQOL, depression) were modelled using linear regression. Results: Overall, 140 participants completed all study assessments (IA: n = 69, RCA: n = 71); n = 108 underwent surgery (IA: n = 49, RCA: n = 59). Regardless of study arm, most participants reported expectations were met, minimal decisional regret, satisfaction with outcomes of knee replacement, and had improvements in HRQOL. While no significant differences in study outcomes were found between study arms, IA results were in the direction hypothesised in favour of the PtDA. Conclusions: Although we were not able to detect statistically significant benefits associated with implementing this PROMs‐based PtDA, there was no apparent negative effect on these outcomes 1 year after baseline. We anticipate there may be benefit to implementing this PtDA earlier in the osteoarthritis care pathway where patients have more opportunities to manage their disease non‐surgically. [ABSTRACT FROM AUTHOR]