Decision coaching for people who make health decisions
Cochrane Database System Rev. 2021 Nov 8 11: CD013385. doi: 10.1002 / 14651858.CD013385.pub2.
BACKGROUND: Decision coaching is non-directive support provided by a health care provider to help patients prepare to actively participate in health decision making. “Health care providers” are considered to be all persons engaged in actions whose main objective is to protect and improve health (for example, nurses, doctors, pharmacists, social workers, health workers, health workers such as peer health workers). Little is known about the effectiveness of decision coaching.
OBJECTIVES: To determine the effects of decision coaching (I) for people facing health care decisions for themselves or a family member (P) versus (C) usual care or intervention based on evidence only, on outcomes (M) related to readiness for decision-making, decision-making needs and potential negative effects.
SEARCH METHODS: We searched the Cochrane Library (Wiley), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science since the creation of the database until June 2021.
SELECTION CRITERIA: We included randomized controlled trials (RCTs) in which the intervention was offered to adults or children preparing to make a treatment or screening decision for themselves or a family member. Decision coaching has been defined as: a) delivered individually by a health care provider trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a health care decision. Comparisons included usual care or an alternative intervention. There was no language restriction.
DATA COLLECTION AND ANALYSIS: Two authors independently sifted citations, assessed risk of bias, and extracted data on intervention characteristics and outcomes. All disagreements were resolved through discussion to reach consensus. We used the standardized mean difference (SMD) with 95% confidence intervals (CI) as measures of treatment effect and, if possible, synthesized the results using a random-effects model. If multiple studies measured the same outcome using different tools, we used a random-effects model to calculate the standardized mean difference (SMD) and 95% CI. We presented the results in results summary tables and applied GRADE methods to assess the certainty of the evidence.
MAIN RESULTS: Of 12,984 citations reviewed, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5,509 adult participants (aged 18-85; 64% female, 52% white, 33% African-American / Black; 68% post-secondary). Studies assessed decision coaching used for a range of healthcare decisions (e.g., treatment decisions for cancer, menopause, mental illness, course of kidney disease; screening decisions cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching versus usual care (n = 4 studies), we do not know whether decision coaching versus usual care improves outcomes (i.e. the evidence was very weak. For decision coaching versus evidence only (n = 4 studies), there is low certainty – evidence that participants exposed to decision coaching may have little or no change in their knowledge (DMS -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is little evidence for certainty that participants exposed to decision coaching may have little or no change in anxiety, compared to the evidence-based information. not if decision coaching over factual information improves other outcomes (ie decision-making self-confidence, feelings of being uninformed) because the certainty of the evidence was very low. decision-making and evidence-based information compared to usual care (n = 17 studies), there is low certainty that participants may have improved their knowledge (SMD 9.3, 95% CI: 6.6 to 12, 1; 5 studies, 1073 participants). We are uncertain whether decision coaching and evidence versus usual care improves other outcomes (i.e. was very low. For decision coaching plus evidence versus evidence only (n = 7 studies), we do not know if decision coaching plus factual information versus factual information only improves outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) because the certainty of the evidence was very low.
AUTHORS ‘CONCLUSIONS: Decision coaching can improve participants’ knowledge when used with factual information. Our results do not indicate any significant adverse effects (eg, decision regret, anxiety) with the use of decision coaching. It is not possible to draw strong conclusions for other results. It is not clear whether decision coaching should always be combined with factual information. More research is needed to establish the effectiveness of decision coaching for a wider range of outcomes.