“When my husband had to make the important decision between surgery and radiation treatment for his cancer, we were overwhelmed by the different perspectives of the experts, each focused solely on their own treatment. No one lays out the options. This is where patient decision support made a huge difference. We felt empowered, informed and confident in our choices. ” — Maureen Smith, caregiver and patient advocate.
Patient decision aids (PDAs), like the one Maureen and her husband used, are evidence-based tools that help individuals make informed decisions about their health care. These tools help patients understand the benefits and risks of each option while clarifying their personal values. Decision aids often include visual tools such as charts and diagrams to simplify complex medical data and help patients make sense of their choices. PDAs also facilitate collaboration between patients and healthcare providers, ensuring that decisions are made in line with both medical expertise and informed patient preferences.
The Cochrane Review, led by Professor Dawn Stacey, analyzed data from over 200 studies and found that PDAs significantly improve patient knowledge, reduce conflict in decision-making and support informed, values-based choices. It turned out. This review examined decision support tools used to make 71 different health decisions, including cardiovascular treatments, cancer screening, mental health care, and joint replacement surgery. Stacey, who has led the review since 2010, said the evidence supporting PDAs has only grown stronger over time, showing that PDAs have a positive impact on both the decision-making process and the quality of the decisions themselves. I explained that PDAs are particularly useful in preparing patients and their families to take a more active role in decision-making.
Maureen's experience reflects this influence. As her husband's primary caregivers, they received input from two different experts. Each focused on a specific treatment without providing a complete comparison of options. Feeling overwhelmed, Maureen turned to patient decision support, which she had learned through her research work. They sat together at the kitchen table and used decision-support tools on their laptops to carefully consider the pros and cons of surgery and radiation.
“We took time to discuss each part and revisit options as needed,” says Maureen. “It allowed me to compare options side by side, understand the long-term implications, and align my decisions with what was really important to my husband.” This process turned an overwhelming situation into a It turned into a structured, informed journey where both husbands felt prepared and supported.
Ultimately, her husband felt confident that he had fully considered all options and opted for surgery. Maureen now looks back with gratitude at the control decision support gave her during a difficult time in her life. “It gave me peace of mind knowing that everything was considered.”
PDAs also offer broader benefits. According to Dawn Stacey, PDA empowers patients by improving their knowledge and understanding of available treatment options. “Patients feel more prepared because they're not trying to learn everything the doctor or nurse said during the appointment,” Stacey says. PDAs provide tools that allow patients to ask better questions about their treatment and engage in meaningful discussions. This improved communication reduces decision-making conflicts and helps patients feel more confident in their choices.
Transforming care through global adoption
The use of decision support is also transforming healthcare systems globally. Following the January 2024 Cochrane review update, Brazil plans to integrate PDAs into the national health system. The initiative aims to shift Brazil's traditional paternalistic medical model, in which doctors often hold the primary decision-making power, toward a more patient-centered approach. Project leader Juliana Souza emphasized the project's goals: “We want to move from a provider-driven approach to a patient-informed approach where patients have a voice in their healthcare decisions.”
The project, which is currently in its formative stages, involves collaboration between Brazilian medical experts, international partners and Cochrane review authors. The team will test implementation in primary care settings and home care programs to assess impact on patient-provider communication and healthcare outcomes. The initiative will run until 2026 and will integrate PDAs into digital healthcare platforms managed by the Ministry of Health to ensure decision support covers a wide range of medical conditions.
Prior to the January 2024 update of the Cochrane review, several countries had already introduced PDAs into their health systems. In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has incorporated PDAs into clinical guidelines and promoted their use to improve patient experience and support shared decision-making across different healthcare disciplines. Germany has launched large-scale projects such as the “SHARE TO CARE'' initiative, which integrates shared decision-making across healthcare settings with support from health insurance companies. Similarly, the Danish initiative, particularly in the southern region of Denmark, involves more than 25,000 healthcare professionals across major hospitals such as Odense University Hospital. These efforts are supported by national policies that encourage patient engagement and evidence-based decision-making.
In Taiwan, the Joint Committee on Taiwan (JCT) under the Ministry of Health and Welfare is developing a national project focused on integrating shared decision-making into clinical practice. This project aims to improve communication between healthcare providers and patients and ensure that treatment decisions are in line with patients' values and preferences.
These global initiatives highlight the increasing acceptance of PDAs in modern medicine. But while the benefits of PDAs are clear, Stacey says they need to be more widely deployed to reach their full potential. “Health care professionals need training on how to involve patients in decision-making and change the way they discuss options with patients,” Stacey explains, adding that individual physicians as well as health care teams need to He added that PDAs work best if they have received such training. Patients should also be encouraged to use them effectively and take an active role in their medical decisions.
Stacey's message is clear. “Patient decision aids work, but they only work if they are used.” The next steps include proper training for health care professionals and increased patient awareness so that PDAs can become world-wide. This includes ensuring that it is integrated into routine medical practice.
