Research Institute for Quality of Life, Romanian Academy, Calea 13 Septembrie, nr 13, Bucharest, Romania.
BMC Med Inform Decis Mak. 2019 Jul 19;19(1):137. doi: 10.1186/s12911-019-0840-x.
This paper presents the preliminary results of a decision-tree analysis of Patient Decision Aids (PDA). PDAs are online or offline tools used to structure health information, elicit relevant values and emphasize the decision as a process, in ways that help patients make more informed health decisions individually or with relevant others.
Twenty PDAs are randomly selected from the International Patient Decision Aids Standards (IPDAS) ( https://decisionaid.ohri.ca/AZlist.html ) approved list. An evaluation tool is built bottom-up and top-down and results are described in terms of communicating uncertainty, completeness of the decision tree, ambiguous or misleading phrasing, overall strategies suggested within personal stories.
Twelve of the analyzed PDAs had branches of the decision tree which were not discussed in the tool and 6 had logically ambiguous phrasing. Many tools included dichotomous options, when the option range was wider. Several options were clustered within the "Do not take/Do not do" option and thus the PDA failed to provide all comparisons necessary to make a decision. Some tools employ expressions that do not differentiate between lack of information and known negative effects. Other tools provide unequal amounts or non-comparable bits of information about the options.
These results indicate a very loose range of interpretations of what constitutes an option, a treatment, and a treatment option. It thus emphasizes a gap between theory and practice in the evaluation of PDAs. Future developments of PDA evaluation tools should keep track of missing decision tree branches, accurate communication of uncertainty, ambiguity, and lack of knowledge and consider using measures for evaluating the completeness of the option spectrum at an agreed period in time.
本文呈现了对患者决策辅助工具（PDA）的决策树分析的初步结果。PDA 是在线或离线工具，用于构建健康信息，引出相关价值观，并强调决策是一个过程，以帮助患者单独或与相关人员更明智地做出健康决策。
从国际患者决策辅助工具标准（IPDAS）（https://decisionaid.ohri.ca/AZlist.html）批准列表中随机选择 20 个 PDA。构建了自下而上和自上而下的评估工具，并根据沟通不确定性、决策树的完整性、模糊或误导性措辞、个人故事中建议的总体策略来描述结果。
分析的 12 个 PDA 的决策树分支在工具中没有讨论，6 个 PDA 的措辞在逻辑上存在歧义。许多工具包括二分选项，而选项范围更宽。几个选项聚类在“不采取/不做”选项内，因此 PDA 未能提供做出决策所需的所有比较。一些工具使用的表达方式没有区分缺乏信息和已知的负面效果。其他工具提供了选项之间不等量或不可比较的信息。
这些结果表明，对于什么构成选项、治疗和治疗选项的解释范围非常广泛。因此，这强调了在 PDA 评估中理论与实践之间的差距。未来的 PDA 评估工具的发展应跟踪缺失的决策树分支、不确定性、歧义、缺乏知识的准确沟通，并考虑使用在商定时间内评估选项范围完整性的措施。
