What are examples of clinical decision aids?
by Daniel J. Power
Editor, DSSResources.COM
A decision aid is a tool that assists a person in making a specific decision. For example, a highway map is a decision aid for trip planning and for making navigation decisions during the trip. Computing a moving average of sales from previous weeks is a sales forecasting decision aid. Clinical decision aids assist in making medical decisions by clinicians, medical staff and patients. Patient decision aids are designed to help patients with certain conditions think about what is important to them when talking with their clinician (AHRQ, 2016).
According to the Mayo Center for Innovation, a "decision aid is a tool used to inform patients about available treatments, along with potential benefits, risks and costs, during clinical encounters. Decision aids use a shared, informed approach to clinical decision-making. Potential outcomes of decision aids include increased patient knowledge of available treatments, greater patient participation in decision-making, and improved patient health status and quality of life." Decision aids have been prototyped in clinical areas including Diabetes,
Statins, Osteoporosis, Depression, and Acute myocardial infarction
According to O'Connor (2001), "Decision aids help patients to participate with their practitioners in making deliberative, personalised choices among healthcare options. ... Decision aids are delivered as self administered tools or practitioner administered tools in one to one or group sessions. Possible media include decision boards, interactive videodiscs, personal computers, audiotapes, audio guided workbooks, and pamphlets."
Types of Clinical Decision Support (CDS) include tools for 1) Immediate Alerts:
warnings and critiques; 2) Event-driven alerts and reminders, 3) Order Sets, Care Plans and Protocols, 4) Parameter Guidance, 5) Smart Documentation
Forms, 6) Relevant Data Summaries (Single-patient), 7) Multi-patient Monitors and
Dashboards, 8) Predictive and Retrospective Analytics, 9) Filtered Reference
Information and Knowledge Resources, and 10) Expert Workup Advisors (HIMSS 2011).
Clinical and patient decision aids, as well as clinical decision support systems, provide the greatest benefit when matched with decision making styles and decision tasks (Fiks, 2011; O'Connor, 2001). Healthcare decisions are made in 3 ways: (1) unilaterally by an expert clinician or clinical team that makes treatment decisions and communicates them to the patient; (2) informed patient where patients reach their own healthcare decisions with information from clinicians or other sources; and (3) shared decision-making (SDM) where discussion of options and medical and personal information exchange occurs between clinicians and families (Charles, et al., 1997; Fiks, 2011). Alston et al. (2014) argue "One way to promote SDM is to provide patients and clinicians with well-designed and structured decision aids, which are tools intended to provide detailed, balanced, evidence-based information about competing treatment options. (p. 4)"
The Mayo Clinic Shared Decision Making National Resource Center philosophy states decision aids are "tools to share information and create a conversation about the options and their relative merits and downsides." The disclaimer states "No decision aid replaces the conversation patients should have with their clinicians to make important, clinical decisions."
Clinical decision support system (CDSS) analyze data to help healthcare providers make decisions and improve patient care. A CDSS often uses knowledge management and rules to provide clinical advice based on multiple factors from patient-related data. Clinical decision support systems enable integrated workflows, provide assistance at the time of care, provide screening, and offer care plan recommendations. In general, clinical decision support systems (CDSSs) are a subtype of expert system that is specifically designed to aid in the process of clinical decision-making (Finlay, 1994).
According to HealthIT.gov (2018), "Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools."
Liu, Wyatt and Altman (2006) "argue that DSSs and other computer-based, paper-based and even mechanical decision aids are members of a wider family of decision tools. A DT is an active knowledge resource that uses patient data to generate case specific advice, which supports decision making about individual patients by health professionals, the patients themselves or others concerned about them."
Decision aids and decision support have become necessary and even critical to providing high quality patient care. Cerrato and Halamka (2019) assert "The diagnosis of disease can become so complex that the human brain is incapable for processing all the possibilities. The latest clinical decision support software can help meet this challenge, using massive informational databases, machine learning, neural networks, and systems biology."
References
Agency for Healthcare Research and Quality (AHRQ), "Patient Decision Aids," last accessed May 20, 2016 at URL http://effectivehealthcare.ahrq.gov/index.cfm/tools-and-resources/patient-decision-aids/
Alston, C., Z. Berger, S. Brownlee, G. Elwyn, F. Fowler Jr., L. Kelly Hall, V. Montori, B. Moulton, L. Paget, B. Shebel, R. Singerman, J. Walker, M. Wynia, and D. Henderson. 2014. Shared DecisionMaking Strategies for Best Care: Patient Decision Aids. Discussion Paper, Institute of Medicine, Washington, DC.
http://nam.edu/wp-content/uploads/2015/06/SDMforBestCare2.pdf.
Cerrato, P. and J. Halamka, "Reinventing Clinical Decision Support: What Role for Mobile Technology?" The Transformative Power of Mobile Medicine, Ch. 7, 2019, Pages 117-143 at URL https://doi.org/10.1016/B978-0-12-814923-2.00007-6
Charles, C., A. Gafni, and T. Whelan, "Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)," Social Science Medicine, 1997;44:681–92 at URL http://www.ncbi.nlm.nih.gov/pubmed/9032835.
Clinical decision support system (CDSS), July 2018 https://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS
Cox, C. E., D. B. White, and A. P. Abernethy, "A Universal Decision Support System. Addressing the Decision-Making Needs of Patients, Families, and Clinicians in the Setting of Critical Illness," American Journal of Respiratory and Critical Care Medicine, Vol. 190, No. 4, Aug 15, 2014 at https://doi.org/10.1164/rccm.201404-0728CP
Fiks, A. G., "Designing Computerized Decision Support That Works for Clinicians and Families," Current Problems in Pediatric Adolescent Health Care, 2011 Mar; 41(3): 60–88 at URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373310/.
HealthIT.gov, "What is Clinical Decision Support (CDS)?" Content last reviewed on April 10, 2018 at URL https://www.healthit.gov/topic/safety/clinical-decision-support
HIMS, "Improving Outcomes with Clinical Decision Support: An
Implementer’s Guide," (Second edition), 2011 published Healthcare
Information and Management Systems Society (HIMSS)
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Little, R.G., T. Manzanares and W. A. Wallace, "Factors Influencing the Selection of Decision Support Systems for Emergency Management: An Empirical Analysis of Current Use and User Preferences," Journal of Contingencies and Crisis Management
Volume 23, Issue 4, pages 266–274, December 2015. at URL http://onlinelibrary.wiley.com/doi/10.1111/1468-5973.12097/abstract .
Liu, J., J. Wyatt and D. G. Altman, "Decision tools in health care: focus on the problem, not the solution," BMC Medical Informatics and Decision Making, 2006, Vol. 6:4 at https://doi.org/10.1186/1472-6947-6-4
Mayo Clinic Shared Decision Making National Resource Center at URL http://shareddecisions.mayoclinic.org/
Mayo Clinic Center for Innovation, "Decision Aids," at URLs http://www.mayo.edu/center-for-innovation/projects/decision-aids and http://centerforinnovation.mayo.edu/decision-aids/
Montori. V. M., M. Breslin, M. Maleska, and A.J. Weymiller, "Creating a conversation: Insights from the development of a decision aid," PLoS Medicine, 2007;4(8):233 at URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939861/.
O'Connor, A., "Using patient decision aids to promote evidence-based decision making," Evidence Based Medicine, Volume 6, Issue 4, 2001, pp. 100-102 at URL http://ebm.bmj.com/content/6/4/100.full
Olson, D. L., Decision Aids for Selection Problems, Springer Series in Operations Research and Financial Engineering, 1996.
Scherer, L. D. and G. Lin, "Decision Aids for Prostate Cancer Screening—The True Potential Remains Unknown," JAMA Intern Med. Published online June 24, 2019 at doi:10.1001/jamainternmed.2019.0753
Last update: 2019-07-11 10:41
Author: Daniel Power
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