To explore better ways to help patients make "tough" healthcare decisions that may have:

To explore better ways to help practitioners support patients making "tough" healthcare decisions.

Research Objectives

We will conduct systematic investigations to:


Some of the contributions of the Patient Decision Aids Research Group include:


New Ottawa Decision Support Framework updated with 20 years of evidence: Evidence was from >250 studies, >100 different decisions, >50,000 patients and 18 countries. All decisional needs categories and decisional needs remained (n=45 studies), baseline Decisional Conflict Scale sub-scores indicated clinically relevant decisional needs, and 11 new manifestations were added. Compared to usual care, decision support interventions were superior (patient decision aids, decision coaching, counselling). Decisional outcomes continue to focus on decision quality and resolution of decisional needs. Secondary outcomes were revised to those sensitive to change across a range of decisions.

The 2017 Cochrane Review of patient decision aids for people facing health treatment or screening decisions was ranked #1 in the Cochrane Library for 2019: cited in 271 articles and 69 clinical practice guidelines. More information.


The announcement from the Canadian Medical Hall of Fame indicated Annette O’Connor OC MScN PhD FCAHS FRSC is one of 6 selected for induction into the Canadian Medical Hall of Fame. Her pioneering work in actively engaging patients in their own treatment and supporting them in shared decision-making with physicians and caregivers, has helped make respect for patient agency an accepted part of enlightened and humane medical practice.


Updated review published on The Cochrane Library.

Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2014 , Issue 1 . Art. No.: CD001431. DOI: 10.1002/14651858.CD001431.pub4


Co-lead on The International Patient Decision Aid Standards (IPDAS) Collaboration's Quality Dimensions: Theoretical Rationales, Current Evidence, and Emerging Issues. A supplement in BMC Medical Informatics and Decision Making.

Developed the Ottawa Patient Decision Aid Development eTraining (ODAT) to help people create a patient decision aid using the Ottawa development process.

Peru ISDM 2013 – International Shared Decision Making Converence: Pacientes @ the centre of healthcare - globalizing shared decision making.


Top Cited Cochrane Review: "Decision aids for people facing health treatment or screening decisions" was cited 70 times in 2011, according to the latest data from the publishers, Wiley. The most cited review of any produced by the Cochrane Consumers and Communication Review Group, and the third most cited review of any in The Cochrane Library (across all topics). This review had 3,136 full text accesses in 2011 and 8,600 Abstract accesses.


Worked with CHEO Family Decision Services to develop the Ottawa Family Decision Guide, a tool that can be used by people facing any kind of difficult health or social decision.

Updated the Ottawa Decision Support Tutorial (ODST)
The ODST is intended for health professionals and others involved in counselling and supporting people making decisions about health or social situations. Access the ODST here.

Grand Opening of the Centre for Practice-Changing Research
The Patient Decision Aid Research Group have moved into the new Centre for Practice-Changing Research. More information here.


Professor Dawn Stacey becomes director of the Patient Decision Aids Research Group.

The Interprofessional Shared Decision Making Model was designed by an interprofessional team to broaden the perspective of shared decision making beyond the patient-practitioner dyad.

Légaré F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J, Dunn S, Elwyn G, Frosch D, Gagnon MP, Harrison MB, Pluye P, Graham ID. Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model. J Interprof Care. 2011 Jan;25(1):18-25. doi: 10.3109/13561820.2010.490502. Epub 2010 Aug 26.

The Ottawa Hospital: Supporting patients in making decisions about their care. Patient decision support implementation research by Geoffrey Dervin and Dawn Stacey featured in the “Pass it On!” series published by the Canadian Health Services Research Foundation.


Advised on U.S. Federal Legislation on shared decision making.

Developed the iShould application, based on the OPDG, for the users of the Facebook social networking platform.

Contributed to update of book on shared patient decision making.

Edwards A, Elwyn G, editors. Shared decision-making in health care: achieving evidence-based patient choice. Oxford; New York: Oxford University Press, 2009.


Developed the Decision Support Analysis Tool (DSAT-10) a research tool to evaluate practitioners' use of decision support during a clinical encounter.

Stacey D, Taljaard M, Drake ER, O'Connor AM. Audit and feedback using the brief Decision Support Analysis Tool (DSAT-10) to evaluate nurse-standardized patient encounters. Patient Education and Counseling 2008; 73:519-525.


Advised on U.S. Washington State Legislation on shared decision making.


Launched the (re-built) International A to Z inventory of Patient Decision Aids on our website to share publicly available patient decision aids; built by A. Saarimaki.


Hosted the International Shared Decision Making Conference.


Co-lead on the International Patient Decision Aids Standards (IPDAS) initiative. More than 100 participants from 14 countries.

Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barratt A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moumjid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T. Developing a quality criteria framework for patient decision aids: an online international Delphi consensus process. British Medical Journal. 2006 Aug 26;333(7565):417.

Published training case studies on the use of patient decision aids.

Tugwell P, O'Connor AM, Santesso NA. A 64 year old woman with knee pain:
Case presentation. BMJ. 2004;328:1362-3.
Case progression. BMJ. 2004;328:1425.
Case outcome. BMJ. 2004;329:38.

Published medical text containing patient decision aids.

O'Connor, Stacey D, Légaré F, Santesso N. Knowledge Translation for Patients: Methods to Support Patients' Participation in Decision Making About Preference-Sensitive Treatment Options in Rheumatology in P. Tugwell, B. Shea, M. Boers, P. Brooks, L.S. Simon, V. Strand & G. Wells (eds), Evidence-Based Rheumatology. BMJ Books. pp. 41-62. 2004.


Developed e-tools to capture and monitor changes in decisional needs.

Developed the Decision Support Analysis Tool (DSAT). Provide tailored feedback on decision supporting strategies.

Guimond P, Bunn H, O'Connor AM, Jacobsen MJ, Tait VK, Drake ER, Graham ID, Stacey D, Elmslie T. Validation of a tool to assess health practitioners' decision support and communication skills. Patient Educ Couns. 2003 Jul;50(3):235-45.

Developed the Ottawa Decision Support Tutorial (ODST) to help practitioners develop knowledge in shared decision making (SDM) and decision support.

Published a national survey of the public's decisional needs regarding medical treatment.

O'Connor AM, Drake ER, Wells GA, Tugwell P, Laupacis A, Elmslie T. A survey of the decision-making needs of Canadians faced with complex health decisions. Health Expect. 2003;6(2):97-109.

Updated and validated the Decision Regret Scale.

Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, Feldman-Stewart D. Validation of a Decision Regret Scale Med Decis Making. 2003;23(4):281-292.

Initiated the A to Z inventory of patient decision aids; designed with consultants from SCION.


Developed the Ottawa Personal Decision Guide (OPDG) a generic patient decision aid for assessing and addressing patients' decisional needs (practitioner-administered and self-administered versions) used in nurse call centres and serving millions.

O'Connor AM, Jacobsen MJ, Stacey D. An evidence-based approach to managing women's decisional conflict. J Obstet Gynecol Neonatal Nurs. 2002;31(5):570-81.


Created a global inventory of patient decision aids.

O'Connor AM, Stacey D, Rovner D, et al. Decision aids for people facing health treatment or screening decision (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update software.

Contributed chapter in the first book on shared patient decision making.

O'Connor AM, Edwards A. The Role of Decision Aids in Promoting Evidence-Based Patients Choice. In Edwards A, Elwyn G, editors. Evidence-Based Patient Choice. Oxford: Oxford University Press; 2001.


Advised on the rollout of decision support services at Dartmouth Hitchcock Medical Center, UK National Health Service and Australia.

Developed other decision support tools:

  • A Guide for People Facing Decisions about Health or Social Situations
  • Ottawa Decision Support Guide: Practitioner Worksheet
  • An information package and treatment decision aid
  • Guide de l'Équipe d'Ottawa pour l'évaluation et la planification des décisions sur le support à la décision
  • Weighing My Own Pros and Cons. A Personal Assessment Worksheet

Lead the first systematic review of randomized trials of patient decision aids published by an international Cochrane Collaboration review team in the British Medical Journal.

O'Connor AM, Rostom A, Fiset V, Tetroe J, Entwistle V, Llewellyn-Thomas H, Holmes-Rovner M, Barry M, Jones J. Decision aids for patients facing health treatment or screening decisions: A Cochrane systematic review. BMJ. 1999;319:731-4.

Published a methods paper on how to develop and evaluate patient decision aids.

O'Connor AM, Fiset V, DeGrasse C, Graham ID, Evans W, Stacey D, Laupacis A, Tugwell P. Decision aids for patients considering health care options: Evidence of efficacy and policy implications. J Natl Cancer Inst Monogr. 1999;25:67-80.


Developed a conceptual framework (Ottawa Decision Support Framework) for managing patients' decisional needs.

O'Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, McPherson R, Bunn H, Graham I, Drake E. A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. Patient Educ Couns. 1998;33(3):267-79.

Developed a workbook and measurement tools for surveying decision making needs of populations.


Published a regional survey of physicians' attitudes toward decision aids.

O'Connor AM, Llewellyn-Thomas HA, Sawka C, Pinfold SP, To T, Harrison DE. Physicians' opinions about decision aids for patients considering systemic adjuvant therapy for axillary-node negative breast cancer. Patient Educ Couns. 1997;30:143-53.


Designed the first clinical nursing course focused on decision support skills. More information about the University of Ottawa course, NSG 6133 - Decision Making in Clinical Practice, here.


Established the Patient Decision Aids Research Group (originally called the Ottawa Health Decision Centre - OHDeC).

Developed the Decisional Conflict Scale (DCS): the first scale to measure changes in decisional needs following counseling (uncertainty about a course of action and related modifiable factors such as feeling uninformed, unclear about personal values, and unsupported in decision making); has become a standard for evaluation.

O'Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25-30.


Published a paper describing clinical strategies when a patient presents with decisional needs such as uncertainty about a course of action.

O'Connor, A., & O'Brien-Pallas, L.L. "Decisional Conflict", in G.K. McFarland and E.A. McFarlane (eds), Nursing Diagnosis and Intervention (Toronto: The C.V. Mosby Company, 1989) pp. 573-588.

Last modified: 2023-02-13.