Quality of Life Research

, Volume 28, Issue 3, pp 593–607 | Cite as

Is quality of life a suitable measure of patient decision aid effectiveness? Sub-analysis of a Cochrane systematic review

  • Claudia RutherfordEmail author
  • Madeleine T. King
  • Phyllis Butow
  • France Legare
  • Anne Lyddiatt
  • Intissar Souli
  • Orlando Rincones
  • Dawn Stacey



Patient decision-aids (PtDAs) help patients make informed treatment decisions incorporating their values. Health-related quality of life (HRQOL) is sometimes an outcome of PtDA effectiveness trials, but its suitability for this purpose is unclear. We sought to provide insights into this question by critically appraising how randomized controlled trials (RCTs) evaluating PtDA effectiveness measure and report HRQOL.


We conducted a sub-analysis of RCTs included in the 2017 Cochrane review of PtDAs. Trials assessing HRQOL at baseline and post-PtDA, and comparing PtDA with comparison groups were included. Two reviewers independently extracted data and assessed study quality. Analysis was descriptive.


Of 105 RCTs, 11 were eligible for inclusion. Patients randomized to PtDAs did not report better HRQOL than those randomized to usual care. While all 11 RCTs adequately described baseline sample characteristics and reported HRQOL results for study groups, few stated a priori HRQOL expectations or hypotheses (36%); made a link between HRQOL and the decision (18%); provided a rationale or justification for HRQOL assessment (18%); provided reason for choice of HRQOL assessment time-points (9%); or adjusted p-values for multiple HRQOL domains and time-points (0%).


PtDAs did not conclusively impact HRQOL. If this holds generally, then HRQOL is an uninformative endpoint for PtDA effectiveness trials. When planning trials of PtDAs, investigators considering HRQOL endpoints should consider whether and why their PtDA is likely to affect HRQOL in their context, and if so, which specific aspect(s) of HRQOL and at which time-point(s), and ensure HRQOL is assessed accordingly.


Quality of life Patient decision aids Shared decision making Randomized controlled trials Cochrane, systematic review 



We thank the authors of the Cochrane review of decision aids for people facing health screening and treatment decisions.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 27 KB)


  1. 1.
    Elwyn, G., O’Connor, A., Stacey, D., Volk, R., Edwards, A., Coulter, A., et al. (2006). Developing a quality criteria framework for patient decision aids: Online international Delphi consensus process. BMJ, 333(7565), 417. Scholar
  2. 2.
    Volk, R., & Llewellyn-Thomas, H. (2012). The 2012 IPDAS Background Document: An Introduction. In R. Volk & H. Llewellyn-Thomas (Eds.), 2012 Update of the International patient Decision Aids Standards (IPDAS) Collaboration’s Background Document.Google Scholar
  3. 3.
    Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., et al. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, Scholar
  4. 4.
    Abhyankar, P., Volk, R., Blumenthal-Barby, J., Bravo, P., Buchholz, A., Ozanne, E., et al. (2013). Balancing the presentation of information and options in patient decision aids: An updated review. BMC Medical Informatics and Decision Making, 13(Suppl 2), S6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Greenhalgh, J., Dalkin, S., Gooding, K., Gibbons, E., Wright, J., Meads, D., et al. (2017). Functionality and feedback: A realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. Health Service Delivery Research, 5(2), 1–280. Scholar
  6. 6.
    Osoba, D. (1994). Lessons learned from measuring health-related quality of life in oncology. Journal of Clinical Oncology, 12(3), 608–616. Scholar
  7. 7.
    Au, H.-J., Ringash, J., Brundage, M., Palmer, M., Richardson, H., & Meyer, R. M. (2010). Added value of health-related quality of life measurement in cancer clinical trials: the experience of the NCIC CTG. Expert Review of Pharmacoeconomics & Outcomes Research, 10(2), 119–128. Scholar
  8. 8.
    Food and Drug Administration. (2009). Patient reported outcome measures: Use in medical product development to support labelling claims. MD: US Department of Health & Human Support Food & Drug Administration.Google Scholar
  9. 9.
    Shay, L. A., & Lafata, J. E. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making, 35(1), 114–131. Scholar
  10. 10.
    Velikova, G., Booth, L., Smith, A. B., Brown, P., Lynch, P., & Brown, J. (2004). Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomised controlled trial. Journal of Clinical Oncology, 22(4), 714–724.CrossRefPubMedGoogle Scholar
  11. 11.
    Brenner, M. H., Curbow, B., & Legro, M. W. (1995). The proximal-distal continuum of multiple health outcome measures: The case of cataract surgery. Medical Care, 33(4 Suppl), As236–A244.PubMedGoogle Scholar
  12. 12.
    King, M. T., Winters, Z. E., Olivotto, I. A., Spillane, A. J., Chua, B. H., Saunders, C., et al. (2017). Patient-reported outcomes in ductal carcinoma in situ: A systematic review. European Journal of Cancer, 71, 95–108. Scholar
  13. 13.
    Calvert, M., Brundage, M., Jacobsen, P. B., Schunemann, H. J., & Efficace, F. (2013). The CONSORT Patient-Reported Outcome (PRO) extension: implications for clinical trials and practice. Health Qual Life Outcomes, 11, 184. Scholar
  14. 14.
    NHS Centre for Reviews and Dissemination. (2001). Undertaking systematic reviews of research on effectiveness: CRD’s guidance for those carrying out or commissioning reviews (2nd edn.). Vol. CRD Report 4). York: University of York.Google Scholar
  15. 15.
    Kennedy, A. D., Sculpher, M. J., Coulter, A., Dwyer, N., Rees, M., Abrams, K. R., et al. (2002). Effects of decision aids for menorrhagia on treatment choices, health outcomes, and costs: a randomized controlled trial. JAMA, 288(21), 2701–2708.CrossRefPubMedGoogle Scholar
  16. 16.
    LeBlanc, A., Wang, A. T., Wyatt, K., Branda, M. E., Shah, N. D., Van Houten, H., et al. (2015). Encounter decision aid vs. clinical decision support or usual care to support patient-centered treatment decisions in osteoporosis: The osteoporosis choice randomized trial II. PLOS ONE, 10(5), e0128063. Scholar
  17. 17.
    McCaffery, K. J., Irwig, L., Turner, R., Chan, S. F., Macaskill, P., Lewicka, M., et al. (2010). Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: An open randomised trial. BMJ, 340, b4491. Scholar
  18. 18.
    Vuorma, S., Rissanen, P., Aalto, A. M., Hurskainen, R., Kujansuu, E., & Teperi, J. (2003). Impact of patient information booklet on treatment decision—a randomized trial among women with heavy menstruation. Health Expectations, 6(4), 290–297. Scholar
  19. 19.
    Knops, A. M., Goossens, A., Ubbink, D. T., Balm, R., Koelemay, M. J., Vahl, A. C., et al. (2014). A decision aid regarding treatment options for patients with an asymptomatic abdominal aortic aneurysm: A randomised clinical trial. European Journal of Vascular and Endovascular Surgery, 48(3), 276–283. Scholar
  20. 20.
    Bernstein, S. J., Skarupski, K. A., Grayson, C. E., Starling, M. R., Bates, E. R., & Eagle, K. A. (1998). A randomized controlled trial of information-giving to patients referred for coronary angiography: Effects on outcomes of care. Health Expectations, 1(1), 50–61.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Morgan, M. W., Deber, R. B., Llewellyn-Thomas, H. A., Gladstone, P., Cusimano, R. J., O’Rourke, K., et al. (2000). Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease. Journal of General Internal Medicine, 15(10), 685–693.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Murray, E., Davis, H., Tai, S. S., Coulter, A., Gray, A., & Haines, A. (2001). Randomised controlled trial of an interactive multimedia decision aid on benign prostatic hypertrophy in primary care. BMJ, 323(7311), 493–496.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Murray, E., Davis, H., Tai, S. S., Coulter, A., Gray, A., & Haines, A. (2001). Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. BMJ, 323(7311), 490–493.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Barry, M., Cherkin, D., Chang, Y., Fowler, F., & Skates, S. (1997). A randomized trial of a multimedia shared decision-making program for men facing a treatment decision for benign prostatic hyperplasia. Disease Management and Clinical Outcomes, 1(1), 5–14.CrossRefGoogle Scholar
  25. 25.
    Protheroe, J., Bower, P., Chew-Graham, C., Peters, T. J., & Fahey, T. (2007). Effectiveness of a computerized decision aid in primary care on decision making and quality of life in menorrhagia: Results of the MENTIP randomized controlled trial. Medical Decision Making, 27(5), 575–584. Scholar
  26. 26.
    Calvert, M., Kyte, D., Mercieca-Bebber, R., Slade, A., Chan, A. W., King, M. T., et al. (2018). Guidelines for inclusion of patient-reported outcomes in clinical trial protocols: The SPIRIT-PRO extension. JAMA, 319(5), 483–494. Scholar
  27. 27.
    Cella, D. F. (1995). Measuring quality of life in palliative care. Seminar in Oncology, 22(2 Suppl 3), 73–81.Google Scholar
  28. 28.
    Revicki, D. A., Osoba, D., Fairclough, D., Barofsky, I., Berzon, R., Leidy, N. K., et al. (2000). Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Quality of Life Research, 9(8), 887–900.CrossRefPubMedGoogle Scholar
  29. 29.
    Gilbert, A., Sebag-Montefiore, D., Davidson, S., & Velikova, G. (2015). Use of patient-reported outcomes to measure symptoms and health related quality of life in the clinic. Gynecologic Oncology, 136(3), 429–439.CrossRefPubMedGoogle Scholar
  30. 30.
    Valderas, J. M., Kotzeva, A., Espallargues, M., Guyatt, G., Ferrans, C. E., Halyard, M. Y., et al. (2008). The impact of measuring patient-reported outcomes in clinical practice: A systematic review of the literature. Quality of Life Research, 17(2), 179–193. Scholar
  31. 31.
    Kashaf, M. S., & McGill, E. (2015). Does shared decision making in cancer treatment improve quality of life? A systematic literature review. Medical Decision Making, 35(8), 1037–1048. Scholar
  32. 32.
    Saheb Kashaf, M., McGill, E. T., & Berger, Z. D. (2017). Shared decision-making and outcomes in type 2 diabetes: A systematic review and meta-analysis. Patient Education Counseling, 100(12), 2159–2171. Scholar
  33. 33.
    McCaffery, K. J., Jansen, J., Scherer, L. D., Thornton, H., Hersch, J., Carter, S. M., et al. (2016). Walking the tightrope: Communicating overdiagnosis in modern healthcare. BMJ, Scholar
  34. 34.
    Luckett, T., & King, M. T. (2010). Choosing patient-reported outcome measures for cancer clinical research–practical principles and an algorithm to assist non-specialist researchers. European Journal of Cancer, 46(18), 3149–3157. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Quality of Life Office, Psycho-Oncology Co-Operative Research Group, School of PsychologyUniversity of SydneySydneyAustralia
  2. 2.Central Clinical School, Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Université Laval Primary Care Research Centre (CERSSPL-UL)Quebec CityCanada
  4. 4.Health ConsumerIngersollCanada
  5. 5.School of NursingUniversity of OttawaOttawaCanada
  6. 6.Ottawa Hospital Research InstituteOttawaCanada
  7. 7.Centre for Oncology Education and Research Translation (CONCERT)Ingham Institute for Applied Medical Research & University of New South WalesSydneyAustralia

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