Treatment consultations: Shared decision-making measures help

screening procedures, diagnosis and choice of treatment yield better outcomes? This question was investigated by an interdisciplinary research team under the direction of DARUM Marion Danner & Anne Rummer GbR in Cologne as part of the IQWiG ThemenCheck Medizin. The researchers evaluated seven systematic reviews, which included around 250 individual studies. Three reviews focussed on decision aids for patients, while the other four examined various other measures for shared decision-making.

Communication at eye level

Applicable ethical and legal rules in Germany and other countries require that patients are to be informed in detail about medical issues. These discussions should take place in such a way that they enable joint decision-making: This means that patients and doctors talk to each other at eye level and decide together in favour of or against a particular treatment. The English term "Shared Decision Making" (SDM) is also often used in Germany. Various measures are intended to provide targeted support for joint decision-making.

Within the framework of ThemenCheck Medizin, one citizen wanted to know, among other things, whether shared decision-making can have an impact on treatment results and patient satisfaction. On behalf of IQWiG, the research team under the direction of DARUM therefore investigated the advantages and disadvantages of SDM measures for the decision-making process - for example, how satisfied patients are with the doctor's consultation or with the decision made. On the other hand, the scientists analysed the health advantages and disadvantages for patients, for example with regard to the symptoms of the disease or the quality of life. To this end, studies were sought on such measures in the treatment of adults - irrespective of the disease.

Particularly decision aids have advantages for the decision-making process

Compared to standard care, the SDM measure "decision aids" showed advantages for six of the analysed 17 SDM-related aspects. For example, decision aids caused patients to be more involved, to have more knowledge about their illness and the treatment options, to be better able to assess risks and to have more confidence in their decision. Although the SDM measure "decision coaching plus evidence-based information" led to more knowledge among those affected compared to standard care, it had no positive influence on other aspects. No advantages or disadvantages were identified for other analysed measures; in some cases there was also too little data.

The individual studies included in the systematic reviews contained significantly less information on the effects of SDM measures on health. Moreover, the quality of most of the studies was rated as low. Overall, therefore, there is no proof of a positive or negative impact of SDM measures on health-related aspects.

The costs for the development and provision of SDM measures cover a wide range. In individual clinical pictures such as breast cancer or gout, the respective SDM measure appeared to be cost-effective; however, generally valid statements on cost-effectiveness were not made on this basis. Regarding the question of whether SDM measures could reduce under-, over- or inappropriate provision of health care and thus increase efficiency in the health care system, the team emphasises that SDM measures are not designed as a control instrument.

Standardized instruments and sound studies are needed

The analysed data show that decision-making aids can support joint decision-making. In order for the data on the effects of SDM measures on SDM and health-related aspects to be better summarized and interpreted in the future, a standardized set of aspects to be investigated and instruments for measuring them is needed - as well as meaningful studies on other SDM measures in addition to decision-making aids.

Find decision aids on www.gesundheitsinformation.de

IQWiG has already developed suitable decision aids in various formats for a number of questions and published them on its website www.gesundheitsinformation.de. The addressed topics include:

• Diabetic foot syndrome: Can amputation be avoided?
• Endometriosis: What treatment options do I have?
• Tonsillitis in children: Should the palatine tonsils be surgically removed?

The range is constantly being expanded. The information material can be downloaded as a PDF free of charge.

ThemenCheck Medizin

Interested parties can submit proposals for the assessment of medical interventions and technologies as part of ThemenCheck Medizin. In a 2-step selection process, which also involves the public, up to 5 new topics are selected each year from among the submitted proposals. According to the legal mandate, these topics are supposed to be of particular relevance to patients. The ThemenCheck reports are not written by IQWiG itself, but by external experts. Their assessment is published together with a generally understandable executive summary and a publisher’s comment by IQWiG.

In September 2023, the Institute published the preliminary results of the report "Treatment discussions: Does joint decision-making between doctor and patient lead to better results in the choice of therapy?" as a preliminary ThemenCheck report and put it up for discussion. After the end of the commenting procedure, the Report was revised and has now been published in its final version.