Step 5: Monitoring Use and Outcomes
Monitor use of decision aids, quality of decision support, and patient outcomes.
5.1 Are decision aids being used? How are they being used?
Determine the number of patients who were eligible to receive the decision aid and the proportion who received one. Ask patients how they are using the decision aid and if there are any other questions. Monitor patient feedback about the decision aid.
5.2 More formal approaches to monitoring the quality of decision support and patient outcomes include
- What is the quality of decision support provided?
Measurement tools are available for monitoring the quality of the decision making process.
- Decision Support Analysis Tool (DSAT-10) was developed to analyze the dialogue between patient and health professional.
- Preparation for Decision Making scale was developed to measure patients' perception of the way they were prepared for making decisions.
- Decision Regret scale was developed to measure patients' perception of regret for a decision made.
- See Evaluation Measures for other instruments for measuring outcomes.
- Are patients and their healthcare professionals reaching higher quality decisions: informed and based on patients' preferences?
Quality decisions are defined as informed with the best available scientific evidence and based on patients' values for outcomes of options (e.g. what is most important to the informed patient). Decision quality can be measured using instruments developed at Massachusetts General Hospital. Their instruments include items relevant to knowledge of the options, strength of importance of outcomes of options (values), and patients' preferred option.
- Are patients more comfortable with the decision (without decisional conflict)?
The SURE Test is 4-items that can be used to screen if the patient feels informed of their options, feels clear about what is most important to them, feels adequately supported with enough advice about the decision and feels sure of the best option. The SURE Test is a screening test for the Decisional Conflict Scale (DCS) intended for use in everyday clinical practice. It can indicate the probability that a patient experiences clinically significant decisional conflict. In the context of this being positive, we recommend administering the full 16 item DCS.
- What are examples of other measures to monitor implementation?
- Hits to web pages
- Attendance at educational sessions
- Frequency and duration of decision support or coaching
- Qualitative interviews or focus groups
5.3 How can findings be used to improve implementation?
Findings on the quality of decision support and patient outcomes (decision quality, decisional conflict. DSAT-10) can be used to provide feedback to health professionals and program managers. Audit and feedback is an effective intervention for changing the behaviour of health professionals (Cochrane Effective Practice and Organization of Care Group).
Last modified: 2019-09-25.