Background
There is a need to better involve people who are making healthcare decisions about treatments (e.g. surgery) or screening (e.g. tests to tell if there is a health problem). Quality decisions are made when people know the best available evidence on options and can share what matters with their healthcare provider(s).
Decision coaching supports people to prepare for making a health decision. It is provided by healthcare providers who are trained or use a protocol for decision coaching (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers).
We wanted to find out if decision coaching helps people to prepare for making healthcare decisions.
What did we do?
We are a team of patient partners, healthcare providers, teachers and researchers from seven countries.
We looked for studies that tested decision coaching with people (adults and children) to prepare them for making a healthcare decision about treatment or screening for themselves or a family member.
We included studies if people who received decision coaching were randomly put into study groups (e.g. using a computer to decide who goes in which group). Studies where people are randomly put into groups are the best way to compare findings between groups and give results we can rely on when we look at the effects of an intervention like decision coaching.
Search strategy
To find studies, we searched eight online data banks. We asked experts and authors of studies about decision coaching. We included studies published up to June 2021.
What we found
We found 28 studies about decision coaching used alone or with high-quality patient information based on research (called ‘evidence-based information’). There was a total of 5509 adults in the 28 studies. None of the studies included children, and only one study included people (parents) making decisions for someone else. The studies tested decision coaching with a range of healthcare decisions such as treatment decisions related to cancer, menopause, or mental illness; cancer screening decisions, and genetic testing.
Some of the studies looked at decision coaching with, or compared to, disease-specific information or evidence-based information such as patient decision aids (booklets, videos, online tools that: make the decision clear, provide options and the pros and cons, and help people be clear on what matters to them).
What does the evidence show?
People who received decision coaching compared with evidence-based information only:
- may have little or no change in knowledge (406 patients, 3 studies);
- may have little of no change in anxiety (242 patients, 1 study).
People who received decision coaching plus evidence-based information compared with usual care:
-may have improved knowledge (1073 patients, 5 studies)
Our confidence in the results
We have low confidence that decision coaching plus evidence-based information improves people’s knowledge compared to usual care. We have low confidence that decision coaching may have little or no effect on knowledge and anxiety compared to evidence-based information. We are less confident about our other findings, as the certainty of the evidence is very low and there were important outcomes that were not reported by the included studies. Many studies had a small number of people taking part and this means that the results of this review might change with more studies.
What this means
Decision coaching may improve peoples’ knowledge to help them prepare to make healthcare decisions when used with evidence-based information. The review did not detect any adverse effects with the use of decision coaching.
Decision coaching may improve participants’ knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. ‘Healthcare providers’ are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers).
Little is known about the effectiveness of decision coaching.
To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects.
We searched the Cochrane Library (Wiley), 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 from database inception to June 2021.
We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions.
Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence.
Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms.
For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low.
For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low.
For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low.
For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low.