20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework

Area of Science:

• Health decision-making
• Patient engagement
• Evidence synthesis

Background:

• The Ottawa Decision Support Framework (ODSF) has guided healthcare decisions for two decades.
• It posits that decision support addressing patient needs enhances decision quality.

Purpose of the Study:

• To update the ODSF using a comprehensive synthesis of current evidence.
• To refine understanding of patient decisional needs and effective support interventions.

Main Methods:

• An overview of systematic reviews was conducted across nine electronic databases.
• Eligible reviews focused on decisional needs, decision support interventions, and outcomes within the ODSF framework.
• Data were narratively synthesized, and the ODSF was revised by expert users.

Main Results:

• Four eligible reviews synthesized data from over 250 studies involving more than 50,000 patients.
• Key decisional needs included inadequate knowledge, unclear values, decisional conflict, and insufficient support, with 11 new manifestations identified.
• Patient decision aids significantly reduced decisional conflict and improved decision quality compared to usual care.

Conclusions:

• The ODSF has been updated to reflect current evidence on patient decisional needs and effective support strategies.
• Revised definitions and new interventions enhance the framework's utility for practitioners and patients.
• Implications for clinical practice and future research directions were identified.