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Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan

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Abstract

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial’s risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients’ perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients’ own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

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Funding

ZP is funded by the National Institute for Health Research (NIHR), Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy. AH is a NIHR funded Academic Clinical Fellow. CJ is part funded by the NIHR Applied Research Collaboration (ARC) West Midlands.

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Authors and Affiliations

  1. Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, ST5 5BG, UK

    Z. Paskins, A. W. Hawarden, L. Bullock, A. Worrall, S. Blackburn & C. Jinks

  2. Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, ST6 7AG, UK

    Z. Paskins & A. W. Hawarden

  3. Knowledge and Evaluation Research Unit, Endocrinology Department, Mayo Clinic, Rochester, MN, USA

    V. D. Torres Roldan, S. Meritxell Urtecho, L. Morera, N. R. Espinoza Suarez & J. P. Brito

  4. Universidad Peruana Cayetano Heredia, Lima, Peru

    G. F. Torres

  5. School of Pharmacy and Bioengineering, Keele University, Staffordshire, ST5 5BG, UK

    S. Chapman

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  1. Z. Paskins
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Correspondence to Z. Paskins.

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Conflicts of interest

Juan P Brito, Victor D Torres Roldan, Meritxell Urtecho S, Nataly R. Espinoza Suarez, and Lisdamys Morera work at the Knowledge and Evaluation Unit at the Mayo Clinic where the Osteoporosis Choice tool was developed. Zoe Paskins, Ashley W Hawarden, Laurna Bullock, Gabriel F Torres, Anne Worrall, Steven Blackburn, Stephen Chapman, and Clare Jinks declare that they have no conflict of interest.

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Paskins, Z., Torres Roldan, V.D., Hawarden, A.W. et al. Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan. Osteoporos Int 31, 1837–1851 (2020). https://doi.org/10.1007/s00198-020-05479-w

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