How Do Patient Decision Aids Enable Purposeful Shared Decision-Making in Rheumatology? An Integrative Review

Shared decision-making (SDM) is a process in which patients and clinicians work together to make health care decisions. Purposeful SDM (PSDM) is a problem-based approach that emphasizes the multifaceted nature of SDM in response to different settings and contexts. In this integrative review, we systematically identify rheumatology patient decision aids (PDAs) described in peer-reviewed published literature and assess how they support PSDM.

Articles were identified through a search of Ovid MEDLINE, EMBASE, CINAHL, and PsycINFO from 1948 to 2023. This search was supplemented through contacting authors and scanning references. The research team analyzed and classified PDAs into 1 of 4 modes. In addition, research team members utilized the SUNDAE Checklist (Standards for UNiversal reporting of Patient Decision Aid Evaluation), a 26-item checklist to assess the quality of manuscripts evaluating PDAs.

Forty-six records met the inclusion criteria. Among the 23 articles containing original data, there were 21 PDAs. The most common conditions represented included rheumatoid arthritis (n=8), osteoarthritis (n=7), and lupus nephritis (n=3). Fifteen addressed weighing treatment options (mode 1), while only 6 addressed intra- or interpersonal conflict (mode 2) and 2 addressed problem-solving (Mode 3). The mean number of SUNDAE checklist criteria satisfied was 21.5 (±4.3).

There exist opportunities to develop and refine tools that (1) address PSDM modes beyond weighing treatment options, (2) cover a wider variety of rheumatologic conditions, and (3) more transparently report evaluation of PDA content, development, and delivery.