Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 2/2013

Open Access 01-11-2013 | Review

Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence

Authors: Dawn Stacey, Jennifer Kryworuchko, Jeff Belkora, B Joyce Davison, Marie-Anne Durand, Karen B Eden, Aubri S Hoffman, Mirjam Koerner, France Légaré, Marie-Chantal Loiselle, Richard L Street Jr

Published in: BMC Medical Informatics and Decision Making | Special Issue 2/2013

Login to get access

Abstract

Background

Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design.

Methods

We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care.

Results

Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs.

Conclusions

Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.
Literature
1.
Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, the International Patient Decision Aid Standards (IPDAS) Collaboration: Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006, 333: 417-422. 10.1136/bmj.38926.629329.AE.PubMedCentralCrossRefPubMed
2.
3.
Stacey D, Murray MA, Légaré F, Dunn S, Menard P, O'Connor A: Decision coaching to support shared decision making: A framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid Based Nurs. 2008, 5: 25-35. 10.1111/j.1741-6787.2007.00108.x.CrossRefPubMed
4.
Stacey D, Kryworuchko J, Bennett C, Murray MA, Mullan S, Légaré F: Decision coaching to prepare patients for making health decisions: A systematic review of decision coaching in trials of patient decision aids. Med Decis Making. 2012, 32: E22-33. 10.1177/0272989X12443311.CrossRefPubMed
5.
Durand MA, Stiel M, Boivin J, Elwyn G: Where is the theory? Evaluating the theoretical frameworks described in decision support technologies. Patient Educ Counsel. 2008, 71: 125-35. 10.1016/j.pec.2007.12.004.CrossRef
6.
Sepucha KR, Fowler FJ, Mulley AG: Policy support for patient-centered care: The need for measurable improvements in decision quality. Health Aff. 2004
7.
Ratliff A, Angell M, Dow R, Kupperman M, Nease R, Fisher R, Fischer ES, Redelmeier DA, Faughnan ME, Rimer BK, Pauker SP, Pauker SG, Sox HC: What is a good decision?. Eff Clin Pract. 1999, 2: 185-197.PubMed
8.
Fishburn P: Normative theories of decision making under risk and under uncertainty. Decision making: Descriptive, normative and prescriptive interactions. Edited by: Bell D, Raiffa H, Tversky A. 1988, New York, NY: Cambridge University Press, 78-98.CrossRef
9.
Howard RA, Matheson JE: The principles and applications of decision analysis. 1989, Menlo Park: Strategic Decision Group
10.
Russo E: Decision traps. Top ten barriers to brilliant decision-making and how to overcome them. 1990, New York, NY: Fireside Publisher
11.
Charles C, Gafni A, Whelan T: Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997, 44: 681-692. 10.1016/S0277-9536(96)00221-3.CrossRefPubMed
12.
Makoul G, Clayman ML: An integrative model of shared decision making in medical encounters. Patient Educ Counsel. 2006, 60: 301-312. 10.1016/j.pec.2005.06.010.CrossRef
13.
Tamblyn R, Abrahamowicz M, Dauphinee D, Wenghofer E, Jacques A, Klass D, Smee S, Blackmore D, Winslade N, Girard N, Du Berger R, Bartman I, Buckeridge DL, Hanley JA: Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA. 2007, 298: 993-1001. 10.1001/jama.298.9.993.CrossRefPubMed
14.
Hack TF, Degner LF, Parker PA: The communication goals and needs of cancer patients: A review. Psycho-Oncology. 2005, 14: 831-845. 10.1002/pon.949.CrossRefPubMed
15.
Kiesler DJ, Auerbach SM: Optimal matches of patient preferences for information, decision-making and interpersonal behaviour: Evidence, models and interventions. Patient Educ Counsel. 2006, 61: 319-341. 10.1016/j.pec.2005.08.002.CrossRef
16.
Donnelley W: Why SOAP is bad for the medical record. Arch Intern Med. 1992, 152: 481-484. 10.1001/archinte.1992.00400150015004.CrossRef
17.
Knowles MS, Holton E, Swanson RA: The adult learner: The definitive classic in adult education and human resource development. 1998, Houston, Texas: Gulf Publishing Company, 5
18.
Knowles MS: The adult learner: A neglected species. 1990, Houston, Texas: Gulf Publishing Company, 4
19.
Mezirow J: Fostering critical reflection in adulthood: A guide to transformative and emancipatory learning. 1990, San Francisco, California: Jossey-Bass Publishers
20.
Bandura A: Self-efficacy mechanism in human agency. Am Psychol. 1982, 37: 122-147.CrossRef
21.
Krueter M, Ricardo W: Tailored and targeted health communication: Strategies for enhancing information relevance. Am J Health Behav. 2003, 27: S227-S232. 10.5993/AJHB.27.1.s3.6.CrossRef
22.
Witt J, Elwyn G, Wood F, Brain K: Decision making and coping in healthcare: The coping in deliberation (CODE) framework. Patient Educ Counsel. 2012, 88: 256-261. 10.1016/j.pec.2012.03.002.CrossRef
23.
Blom KA, Montgomery H: Perspectives and emotions in personal decision making. Decision making cognitive models and explanations. Edited by: Ranyard R, Crozier WR, Svenson O. 1997, London, UK: Routledge, 72-89.
24.
O'Connor AM: Validation of a Decisional Conflict Scale. Med Decis Making. 1995, 15: 25-30. 10.1177/0272989X9501500105.CrossRefPubMed
25.
Bekker HL, Legaré F, Stacey D, O'Connor AM, Lemyre L: Is anxiety a suitable measure of decision aid effectiveness: a systematic review?. Patient Educ Counsel. 2003, 50: 255-262. 10.1016/S0738-3991(03)00045-4.CrossRef
26.
Belkora J: Promoting critical reflection in breast cancer decision making. Shared decision-making in health care: Achieving evidence-based patient choice. Edited by: Edwards A, Elwyn G. 2009, Oxford: Oxford University Press, 297-204.
27.
Légaré F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J, Dunn S, Elwyn G, Frosch D, Gagnon MP, Harrison MB, Pluye P, Graham ID: Interprofessionalism and shared decision-making in primary care: A stepwise approach towards a new model. J Interprof Care. 2011, 25: 18-25. 10.3109/13561820.2010.490502.PubMedCentralCrossRefPubMed
28.
Légaré F, Stacey D, Gagnon S, Dunn S, Pluye P, Frosch D, Kryworuchko J, Elwyn G, Gagnon MP, Graham ID: Validating a conceptual model for an interprofessional approach to shared decision making: A mixed methods study. J Eval Clin Pract. 2011, 17: 554-564. 10.1111/j.1365-2753.2010.01515.x.PubMedCentralCrossRefPubMed
29.
Stacey D, Légaré F, Pouliot S, Kryworuchko J, Dunn S: Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis. Patient Educ Counsel. 2010, 80: 164-172. 10.1016/j.pec.2009.10.015.CrossRef
30.
Légaré F, Stacey D, Briere N, Fraser K, Desroches S, Dumont S, Sales A, Puma C, Aube D: Healthcare providers' intentions to engage in an interprofessional approach to shared decision making in home care programs: A mixed methods study. J Interprof Care. 2013, 1-9.
31.
Kryworuchko J, Stacey D, Peterson WE, Heyland DK, Graham ID: A qualitative study of family involvement in decisions about life support in the intensive care unit. Am J Hosp Palliat Medicine. 2012, 29: 36-46. 10.1177/1049909111414176.CrossRef
32.
de Rosenroll A: Perspectives of patients' significant others in dialysis modality decision making. 2011, University of Ottawa, Ottawa, Canada, Master's of Science in Nursing
33.
O'Connor AM, Tugwell P, Wells G, Elmslie T, Jolly E, Hollingworth G: A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. Patient Educ Counsel. 1998, 33: 267-279. 10.1016/S0738-3991(98)00026-3.CrossRef
34.
Stacey D, O'Connor AM, Graham ID, Pomey MP: Randomized controlled trial of the effectiveness of an intervention to implement evidence-based patient decision support in a nursing call centre. J Telemed Telecare. 2006, 12: 410-415. 10.1258/135763306779378663.CrossRefPubMed
35.
Stacey D, Chambers SK, Jacobsen MJ, Dunn J: Overcoming barriers to cancer helpline professionals providing decision support for callers" An implementation study. Oncol Nurs Forum. 2008, 35: 1-9. 10.1188/08.ONF.E1-E11.CrossRef
36.
Murray MA, Stacey D, Wilson KG, O'Connor AM: Skills training to support patients considering location of end-of-life care: A randomized control trial. J Palliat Care. 2010, 26: 112-121.PubMed
37.
Belkora J, Loth MK, Chen DF, Chen JY, Volz S, Esserman LJ: Monitoring the implementation of Consultation Planning, Recording, and Summarizing in a breast care centre. Patient Educ Counsel. 2008, 73: 536-543. 10.1016/j.pec.2008.07.037.CrossRef
38.
Belkora J, Loth MK, Volz S, Rugo HS: Implementing decision and communication aids to facilitate patient-centred care in breast cancer: A case study. Patient Educ Counsel. 2009, 77: 360-368. 10.1016/j.pec.2009.09.012.CrossRef
39.
Belkora JK, Teng A, Volz S, Loth MK, Esserman LJ: Expanding the reach of decision and communication aids in a breast care center: A quality improvement study. Patient Educ Counsel. 2010, 83: 234-239.CrossRef
40.
Hacking B, Wallace LM, Scott S, Kosmala-Anderson J, Belkora J, McNeill A: Decision navigation intervention for early stage prostate cancer patients in Scotland - A randomised controlled trial. Psycho-Oncology. 2012, epub May 9
41.
Belkora J, Stupar L, O'Donnell S, Loucks A, Moore D, Jupiter C, Johnson N, Wilson L: Decision support by telephone: Randomized controlled trial in a rural community setting. Patient Educ Counsel. 2012, 89: 134-142. 10.1016/j.pec.2012.06.009.CrossRef
42.
43.
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011, 1-208.
44.
Légaré F, Politi M, Drolet R, Desroches S, Stacey D, Bekker H, the SDM-CPD Team: Training health professionals in shared decision making: An international environmental scan. Patient Educ Counsel. 2012, 88: 159-169. 10.1016/j.pec.2012.01.002.CrossRef
45.
Bekker HL, Hewison J, Thornton JG: Applying decision analysis to facilitate informed decision making about prenatal diagnosis for Down syndrome: a randomised controlled trial. Prenatal Diagnosis. 2004, 24: 265-275. 10.1002/pd.851.CrossRefPubMed
46.
Green MJ, Peterson SK, Baker MW, Harper GR, Friedman LC, Rubinstein WS, Mauger DT: Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility: A randomized controlled trial. JAMA. 2004, 292: 442-452. 10.1001/jama.292.4.442.PubMedCentralCrossRefPubMed
47.
Lalonde L, O'Connor AM, Duguay P, Brassard J, Drake E, Grover SA: Evaluation of a decision aid and a personal risk profile in community pharmacy for patients considering options to improve cardiovascular health: the OPTIONS pilot study. Int J Pharm Pract. 2006, 14: 51-62. 10.1211/ijpp.14.1.0007.CrossRef
48.
Miller SM, Fleisher L, Roussi P, Buzaglo JS, Schnoll R, Slater E, Raysor S, Popa-Mabe M: Facilitating informed decision making about breast cancer risk and genetic counseling among women calling the NCI's Cancer Information Service. Journal of Health Communication. 2005, 10: 119-136. 10.1080/07366290500265335.CrossRefPubMed
49.
Solberg LI, Asche SE, Sepucha K, Thygeson NM, Madden JE, Morrissey L, Kraemer KK, Anderson LH: Informed choice assistance for women making uterine fibroid treatment decisions: A practical clinical trial. Med Decis Making. 2010, 30: 444-452. 10.1177/0272989X09353947.CrossRefPubMed
50.
Wolf AM, Nasser JF, Schorling JB: The impact of informed consent on patient interest in prostate-specific antigen screening. Arch Intern Med. 1996, 156: 1333-1336. 10.1001/archinte.1996.00440110105014.CrossRefPubMed
51.
Wolf AMD, Schorling JB: Does informed consent alter elderly patients preferences for colorectal cancer screening?. J Gen Intern Med. 2000, 15: 24-30. 10.1046/j.1525-1497.2000.01079.x.PubMedCentralCrossRefPubMed
52.
Fraenkel L, Rabidou N, Wittink D, Fried T: Improving informed decision-making for patients with knee pain. J Rheumatol. 2007, 34: 1894-1898.PubMed
53.
Jones LA, Weymiller AJ, Shah N, Bryant SC, Christianson TJH, Guyatt GH, Gafni A, Smith SA, Montori VM: Should clinicians deliver decision aids? Further exploration of the statin choice randomized trial results. Med Decis Making. 2009, 29: 468-474. 10.1177/0272989X09333120.CrossRefPubMed
54.
Griffin SJ, Kinmonth AL, Veltman MW, Gillard S, Grant J, Stewart M: Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: A systematic review of trials. Ann Fam Med. 2004, 2: 595-608. 10.1370/afm.142.PubMedCentralCrossRefPubMed
55.
Harrington J, Noble LM, Newman SP: Improving patients' communication with doctors: A systematic review of intervention studies. Patient Educ Counsel.
56.
Wennberg DE, Marr A, Lang L, O'Malley S, Bennett G: A randomized trial of a telephone care-management strategy. NEJM. 2010, 363: 1245-1255. 10.1056/NEJMsa0902321.CrossRefPubMed
57.
Greenfield S, Kaplan S, Ware JE: Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985, 102: 520-528. 10.7326/0003-4819-102-4-520.CrossRefPubMed
58.
Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJ: Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988, 3: 448-457. 10.1007/BF02595921.CrossRefPubMed
59.
Roter D: Doctors talking with patients/patients talking with doctors: Improving communication in medical visits. 1993, Westport, CT: Auburn House
60.
Bennett AEE: Communication between doctors and patients. 1976, Oxford, UK: Oxford University Press
61.
Bensing JM, Dronkers J: Instrumental and affective aspects of physician behavior. Med Care. 1992, 39: 283-298.CrossRef
62.
Cegala DJ, Socha McGee D, McNeilis KS: Components of patients' and doctors' perceptions of communication competence during a primary care medical interview. Health Commun. 1996, 8: 1-27. 10.1207/s15327027hc0801_1.CrossRef
63.
64.
Woolf SH, Chan ECY, Harris R, Sheridan SL, Braddock CH, Kaplan RM, Krist A, O'Connor AM, Tunis S: Promoting informed choice: Transforming health care to dispense knowledge for decision making. Ann Intern Med. 2005, 143: 293-300. 10.7326/0003-4819-143-4-200508160-00010.CrossRefPubMed
65.
66.
Stacey D, Hawker G, Dervin G, Tomek I, Cochran N, Tugwell P, O'Connor AM: Improving shared decision making in osteoarthritis. BMJ. 2008, 336: 954-955. 10.1136/bmj.39520.699190.94.PubMedCentralCrossRefPubMed
67.
Stacey D, Graham ID, O'Connor AM, Pomey MP: Barriers and facilitators influencing call centre nurses' decision support for callers facing values-sensitive decisions: A mixed methods study. Worldviews on Evid Based Nurs. 2005, 2: 184-195. 10.1111/j.1741-6787.2005.00035.x.CrossRef
68.
Montori VM, Gafni A, Charles C: A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect. 2006, 9: 25-36. 10.1111/j.1369-7625.2006.00359.x.CrossRefPubMed
69.
Hamann J, Langer B, Winkler V, Busch R, Cohen R, Leucht S, Kissling W: Shared decision making for in-patients with schizophrenia. Acta Psychiat Scand. 2006, 114: 265-273. 10.1111/j.1600-0447.2006.00798.x.CrossRefPubMed
70.
Lerman C, Biesecker BB, Benkendorf JL, Kemer J, Gomez-Caminero A, Hughes C, Reed MM: Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst. 1997, 89: 148-157. 10.1093/jnci/89.2.148.CrossRefPubMed
71.
van Peperstraten A, Nelen W, Grol R, Zielhuis G, Adang E, Stalmeier P, Hermens R, Kremer J: The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in invitro fertilisation: Randomised controlled trial. BMJ. 2010, 340: 1-8.
72.
Kennedy A, Sculpher MJ, Coulter A, Dwyer N, Rees M, Abrams KR, Horsley S, Cowley D, Kidson C, Kirwin C, Naish C, Stirrat G: Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs. A randomized controlled trial. J Am Med Assoc. 2002, 288: 2701-2708. 10.1001/jama.288.21.2701.CrossRef
73.
Vodermaier A, Caspari C, Koehm J, Kahlert S, Ditsch N, Untch M: Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer. Brit J Cancer. 2009, 100: 590-597. 10.1038/sj.bjc.6604916.PubMedCentralCrossRefPubMed
74.
Rothert ML, Holmes-Rovner M, Rovner D, Kroll J, Breer L, Talarczyk G, Schmitt N, Padonu G, Wills C: An educational intervention as decision support for menopausal women. Res Nurs Health. 1997, 20: 377-387. 10.1002/(SICI)1098-240X(199710)20:5<377::AID-NUR2>3.0.CO;2-L.CrossRefPubMed
75.
Deschamps MA, Taylor JG, Neubauer SL, Whiting S, Green K: Impact of pharmacist consultation versus a decision aid on decision making regarding hormone replacement therapy. Int J Pharm Pract. 2004, 12: 21-28. 10.1211/0022357022999.CrossRef
76.
Green MJ, Biesecker BB, McInerney AM, Mauger D, Fost N: An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility. Am J Med Genet. 2001, 103: 16-23. 10.1002/ajmg.1500.CrossRefPubMed
77.
Hunter AGW, Cappelli M, Humphreys L, Allanson JE, Chiu TT, Peeters C, Moher D, Zimak A: A randomized trial comparing alternative approaches to prenatal diagnosis counseling in advanced maternal age patients. Clin Genet. 2005, 67: 303-313. 10.1111/j.1399-0004.2004.00405.x.CrossRefPubMed
78.
Davison BJ, Degner L: Empowerment of men newly diagnosed with prostate cancer. Cancer Nurs. 1997, 20: 187-196. 10.1097/00002820-199706000-00004.CrossRefPubMed
79.
Myers RE, Daskalakis C, Cocroft J, Kunkel EJS, Delmoor E, Liberatore M, Nydick RL, Brown ER, Gay RN, Powell T, Powell RL: Preparing African-American men in community primary care practices to decide whether or not to have prostate cancer screening. J Natl Med Assoc. 2005, 97: 1143-1154.PubMedCentralPubMed
Metadata
Title
Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence
Authors
Dawn Stacey
Jennifer Kryworuchko
Jeff Belkora
B Joyce Davison
Marie-Anne Durand
Karen B Eden
Aubri S Hoffman
Mirjam Koerner
France Légaré
Marie-Chantal Loiselle
Richard L Street Jr
Publication date
01-11-2013
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1472-6947-13-S2-S11

Other articles of this Special Issue 2/2013

BMC Medical Informatics and Decision Making 2/2013 Go to the issue

Review

Providing information about options in patient decision aids

Review

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

Review

Balancing the presentation of information and options in patient decision aids: an updated review

Review

A systematic development process for patient decision aids

Review

Clarifying values: an updated review

Review

Establishing the effectiveness of patient decision aids: key constructs and measurement instruments