G IRISH1,2,3, A WEIGHTMAN 1,2, J HERSCH 4, P COATES 2,3,P CLAYTON 1,2,3
1Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 2Department of Medicine, University of Adelaide, Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 4School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia, COLLINSWOOD, Australia
Aim: To assess if patient decision aids help with decision making in solid organ transplantation.
Background: Decisions about solid organ transplantation are complex. The best decision for a patient will depend on their values, including the relative importance of benefits, harms and uncertainty. Patient decision aids add to traditional education by encouraging patients to identify their values and align these with treatment options. In other fields, decision aids have been shown to increase knowledge, decision quality and patient involvement in health-care decisions.
Method: We included all primary studies of decision aids designed for adult patients, donors and clinicians for use in decisions regarding solid organ transplantation. Decision aids were defined based on the International Patients Decision Aid Standards. All comparators and outcomes were included. We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE, EBSCO and PsychINFO databases in November 2020. All abstracts were screened by 2 reviewers. Disagreements were resolved with a 3rd reviewer. Bias evaluation was performed based on different study types. The study protocol was registered with PROSPERO(CRD42020215940).
Results:7463 studies were screened for inclusion. 163 studies underwent full text review for eligibility. 15 studies underwent data extraction. The studies were primarily for kidney transplantation (12 kidney, 2 lung, 1 liver). Nine studies were randomised controlled trials. Seven studies assessed outcome of knowledge; all demonstrated increase in patient knowledge with patient decision aid use. Four could be combined for meta-analysis (mean knowledge difference 6.78;95%CI 0-13.55). The other outcomes such as decisional conflict and self-efficacy were too heterogeneous for meta-analysis.
Conclusion:In solid organ transplantation, patient decision aids increase knowledge. It is unclear whether their use affects other markers of decision quality.
Dr Georgina L Irish is an Australian Nephrologist working at The Royal Adelaide Hospital. She undertook medical school at The University of Adelaide and her nephrology training at The Royal Adelaide Hospital and Flinders Medical centre before moving to Oxford in the United Kingdom. She is undertaking her Masters of Clinical Epidemiology through the University of Sydney. Georgina is undertaking a PhD on Decision making in Kidney transplantation through the University of Adelaide. She will be using epidemiological registry data to help inform decisions around kidney transplantation.