We all want practical solutions to achieve better care.
Shared Decision Making (SDM) involves patients and their healthcare provides making choices about care together; they consider the current evidence, discuss the potential benefits and risks of each option, enabling the patient to make an informed choice about the next step in their care.
SDM aids are clinical tools that a patient and their provider can use to facilitate this type of discussion. SDM and other tools to facilitate more appropriate care include videos, handouts, apps, and web resources. Some of the most straight-forward and useful ones are collected here.
This section is under development; resources are added regularly.
*HealthyDebate featured a helpful article: Decision aids: why hasn’t this proven, patient-centred practice caught on? It's a good place to start if you are new to this way of cooperating between patient and provider.*
Decision Aids 101 (subscription required) has created a toolkit to give managers the resources they need to help frontline clinicians incorporate patient input into care decisions, i.e. to do shared decision
Shared Decision Making (SDM) aids, Sample Conversations, Handouts & Videos
NON-DISEASE SPECIFIC / CReate your own tool or icon image
Icon Array [website, generates web-embeddable or downloaded diagram] from The University of Michigan's The Risk Science Center and the Center for Bioethics & Social Sciences in Medicine, this is a comprehensive tool for building icon arrays that could be used for shared decision-making. They offer basic as well as advanced versions, or sets of images that allow the display of 2 or 3 risks/benefits. If you aren't sure how do get started, see the examples.
Shared Decision Making (SDM) Made Easy! [PDF, 1 page] created by Ricky Turgeon (@Ricky_NERDLMPS). A simple overview and approach to shared decision making, great cheat-sheet if you are just starting out; best for health care providers to guide interactions with patients
The Empowered Patient Decision Support App [website, generates PDF] 10 questions that help identify areas in which patients may need help and support when making health care decisions; the app produces a pdf report of areas where the patient feels confident and decisive – and areas in which the patient may need information and guidance.
Ottawa Personal Decision Guide for people making health or social decisions [PDF template] patients can use this to work through any major decision; on their site, the guide is available in other languages and a "family" guide is also available
Make your own! [SDM tools for NNT/NNH] from VisualRx by Dr Chris Cates: An online tool that can help you create your own visual representation of risks/benefit likelihoods from data of your choosing
B.R.A.I.N. decision aid [PDF, 1 page] adapted from the International Childbirth Association by the Centre for Collaboration, Motivation, and Innovation: A generic decision aid that can be used for making any important medical choice
The Instrument for Patient Capacity Assessment (ICAN) [prototype, PDF, 2 pages] from Minimally Disruptive Medicine: a clinical encounter discussion aid that is designed to help patients and health professionals discuss areas of the patient’s life and issues in treatment for context-centered care. It promotes consideration of the ways in which life, the pursuit of health, and healthcare interact. More info.
Relative vs Absolute risk explanation tools for patients
Comprehensive DATABASES with disease-specific tools:
Alphabetical List of Decision Aids by Health Topic, from The Ottawa Hospital Research Institute (OHRI): [list] a collection of Decision Aids rated according to the International Patient Decision Aid Standards (IPDAS); many of the tools they include are from HealthWise Decision Point
Brief Decision Aids [PDFs] from NHS. Various topics like treatment for contraception choices, smoking cessation, and warts are covered in these PDFs from the National Health Service in the UK
Choosing Wisely Canada Patient Handouts [PDFs] plain language and patient-friendly materials to complement the lists of specialty recommendations of “Five Things Clinicians and Patients Should Question."
Choosing Wisely Canada & Capital Health (Halifax) [general videos] General overview of the principles and practice behind Choosing Wisely and appropriateness in healthcare; slightly unfocussed but persuasive messages
CFPC/Choosing Wisely Canada Toolkit [PDFs and video] A multimedia toolkit equips health care providers with user-friendly videos, printable posters for their clinics, and printable infographics designed to facilitate informed discussions and give patients resources they can take home.
Option Grids [pdf grids] from the Decision Laboratory of Cardiff University and The Dartmouth Center for Health Care Delivery Science, these are grids that help compare options for patients when confronted with a decision eg. tonsillectomy vs conservative management for tonsillitis, the risks a and benefits of employment for patients with mental health diagnoses, pros and cons of newborn circumcision
not sure how to use these? a video demonstrating how to use Option Grids is available
Getting Under Our Skin [cartoon videos] from TEDTalks that answer basic questions such as "How does the thyroid manage metabolism?," "What causes antibiotic resistance?," and "What are those floaty things in your eye?"
Decision Box [shared decision tool] (also in French) 1-2 page PDFs help with decisions by highlighting benefits and harms of a test or intervention; a partnership of McMaster and Université Laval on topics such as BRCA gene screening, and PSA testing; a little out of date.
Patient Decision Aids [SDM tools & handouts] from the NHS National Prescribing Centre: In a limited number of areas, this site provides handouts and other tools to help with decision-making. Eg. Conjunctivitis Patient Decision Making Aid [handout]
Risk Calculators [clinical calculators] from the Therapeutics Education Collaborative: An extensive list of the available calculators for disease risk, ranging from Framingham to FRAX and beyond
Shared Decisions [interactive website] from the Mayo Clinic: Osteoporosis, Cardiovascular, Diabetes treatment and Depression treatment interactive aids help patients learn more about therapies and make the right choice. Some issues with the data but nice interface
Therapy (NNT) reviews by Specialty [NNT and absolute risk reduction numbers] from the NNT.com: Quick snapshots of evidence of benefit of various interventions
Communication Modules [sample conversations] from Choosing Wisely: These modules walk healthcare providers through the 5 Choosing Wisely recommendations from each specialty group; there is a pre-test to evaluate current practice, an explanation of the rational behind Choosing Wisely, tips and videos about how to provide clear information based on best evidence, and "Key Communication Concepts" for each of the 5 recommendations, and links to the patient handouts
NHS Decision Aids (restricted to the UK) from the National Health Service (NHS)
Choosing Wisely Canada App [iOS/Google Play App] from Choosing Wisely Canada: contains physician recommendations and patient handouts
Tandem Health App [iOS/Android/Web App] (Beta) from Consumer Reports/National Physicians Alliance (NPA): This application was developed by consumers and providers together—for them to use together. It covers care options for the most common medical needs
Testing for Cancer: My Options, My Choice [PDF] from The Centre for Effective Practice: Canadian Guide that walks patients through cancer screening, investigation
Risks and Benefits of Breast Cancer Screening [infographic/fact boxes] from The Harding Center for Risk Literacy: a set of infographics created with the results of the Cochrane Systematic Review regarding the utility and benefits/harms of breast cancer screening with mammography
Breast Screening Decisions age 40-49: [online decision tool] from Weill Cornell Medical College: a tool that helps women 40-49 decide if mammography benefit may outweigh risks for their profile (based on risk factors)
Breast Cancer Screening Decision Aid [online questionnaire] from BC Cancer Agency: a tool that asks 6 simple questions to help a patient decide if the benefits outweigh the risks for screening mammography LIMITATIONS: Doesn't discourage screening for those 40-49, doesn't mention chance of detecting indolent cancers that would never have harmed a person
Mammogram Theatre: Lazris & Rifkin's Risk-Benefit Characterization Theater [video] from Kaiser Permanente: a video that uses iconarrays and the analogy of a theatre of 1000 people to help patients to learn about the risks and benefits of mammography with a realistic depiction of pros and cons
Helping you decide about Lung Cancer Screening [PDF] from the Dartmouth-Hitchcock Norris Cotton Cancer Centre: a 2 page summary of the risks and benefits of lung cancer screening with CT for heavy smokers
Risks and Benefits of Prostate Cancer Screening [infographic/fact boxes] from The Harding Center for Risk Literacy: a set of infographics created with the results of the Cochrane Systematic Review regarding the utility and benefits/harms of prostate cancer screening with PSA
Patient and Physician Guide: National Lung Screening Trial (NLST) [PDF] from the National Cancer Institute (NCI): a one-page summary of the results of the NLST laid out in a way that could be used as a shared decision-making tool with patients for CT-screening of lung cancer
Screening for Lung Cancer [PDF handout] from the US Department of Veterans Affairs: a great handout with infographic for patients considering CT-screening for lung cancer
Aspirin and statin decision making aid [interactive website], from the Mayo Clinic: an online calculator for use in the office with patient and clinicians to help decide on the appropriateness of statins and ASA for patients to reduce cardiovascular risk
The Guidelines Battle on Starting Statins [article with 3 scenarios], from the Lancet: a case approach with three different approaches to deciding whether to start statins for primary prevention
Cardiovascular Risk/Benefit Calculator [interactive website], from Therapeutics Education Collaboration: an online/offline calculator is an interactive and individualized tool which provides an absolute estimate (%) of a person's chance of having a cardiovascular event, over a specific period of time and an idea of the potential benefit of specific treatments
SPARCTool [online calculator] by Peter Loewen, "Stroke Prevention in Atrial Fibrillation Risk Tool" for estimating risk of stroke and benefits & risks of antithrombotic therapy in patients with chronic atrial fibrillation , incorporates CHADS2/CHA2DS2-VASc and HAS-BLED and shows stats on efficacy/risk of antiplatelets, coumadin, novel anti-coagulants, etc.
Should I put my relative with Alzheimer's disease in a nursing home? [PDF] from HealthWise: The decision to put a relative with Alzheimer's disease (or any Dementia) in a nursing home is often a difficult one. Caring for someone with Alzheimer's disease at home requires significant social, financial, and personal sacrifices. Every family has different needs, preferences, and constraints to think about.
Antibiotic prescribing fact sheet [PDF] from the CDC: A guide for hospital prescribers to reduce antibiotic overuse in hospitals, in efforts to decrease adverse events including C. difficile and the development of Antibiotic Resistant Organisms (AROs)
Mental Health Patient Care Resources [collection] from Medication InfoShare: a limited collection of tools, some oriented to the health provider and others to the patient; they help guide discussion around starting and stopping mental health medications, encountering side effects, and accessing mental health resources
Deprescribing guide for Antipsychotic drugs in the elderly, by Dr Cara Tannenbaum at Centre de Recherche, Institut de gériatrie de Montréal
BPSD Management Algorithm: a practical, interactive tool intended to support interdisciplinary, evidence-based, person-centred care for persons with behavioural and psychological symptoms of dementia (BPSD); a bit complicated, mostly for clinicians but has lots of information about non-pharmacologic interventions
Informed consent for Benzodiazepine Prescription by Benzodiazepine Information Coalition: A template for a prescribing contract between clinician and patient, which outlines harms and benefits of a benzodiazepine prescription
Shared Decision-Making Low Back Pain Patient Available Tools - Maine Quality Counts: A list of tools covering topics ranging from MRIs to epidural injections to spinal manipulation or surgeries [some are not very up to date]
Low Back Pain [video] from Dr Mike Evans: A great video for patients to learn more about the diagnosis and treatment of lower back pain and when imaging is appropriate. Most lower back pain is within your power to manage!
Obstetrics & Gynecology
Prenatal Screening: Is It Right for You? [35 min Video] from the Dartmouth-Hitchcock Norris Cotton Cancer Centre: Are you considering prenatal screening for Down syndrome, neural tube defects and trisomy 18? If so, this video may help you decide whether or not screening is right for you. It shows a range of options and outcomes. Download the companion booklet to this video. LIMITATIONS: Long video, some USA-specific content
Prenatal Genetic Screening Program BC - some videos, shared decision-making graphic tool / visual aid tool, pamphlets in multiple languages and a handy FAQ section; with all these various formats, every clinician or patient can find a style of learning tool that can help them work through the decision of whether maternal serum screening is the right choice
Palliative Care/GOALS OF CARE
Advance Care Planning [PDFs] from the British Columbia Ministry of Health. For information on advance care planning information including videos (Punjabi and Simplified Chinese subtitles available), brochures, tips on completing your advance care plan, or answers to frequently asked questions (including legalese) this provides a pretty comprehensive
A Decision Aid about Goals of Care for Patients with Dementia [video, 21 min] from the University of North Carolina at Chapel Hill. Shown to improve end-of-life communication with clinicians: using this tool, clinicians were more likely to address palliative care in treatment plans, use Medical Orders for Scope of Treatment, and were less likely to send patients to the hospital (JAMA Int Med)
This decision aid can help to prepare and educate families who must make health care decisions for people with advanced dementia. Family members should view the decision aid before they have a care plan discussion or meet with the patient’s physician.
Reducing Polypharmacy: A logical approach [podcast/stepwise article] from the Therapeutics Initiative
Are you taking too much medicine? [quiz/tool for patients] Ask your doctor if this pill is wrong for you (some background information)
Deprescribing guidelines for the elderly [website] from OPEN, Ontario Pharmacy Research Collaboration. Deprescribing help for PPIs, benzodiazepines, and antipsychotics. These guidelines will support interdisciplinary teams of healthcare professionals in tapering or stopping medications that may be causing harm or are no longer providing benefit as well as monitoring for adverse drug withdrawal reactions in elderly patients. The project’s research team expects that this will reduce adverse drug effects and improve quality of life.
SafeMedicationUse.ca [website, multiple tools] Various resources to help patients keep a list of their medications
Geriatric Medication Management Toolkit [website, multiple tools] "To help homecare professionals address one of the most challenging and complex problems confronting older persons with multiple chronic conditions -- managing multiple and high-risk medications -- CHAMP selected and organized evidence-based tools from our Resource Library into this online Geriatric Medication Management Toolkit."
Deprescribing Algorithms - Canadian Deprescribing Network
Antipsychotic deprescribing algorithm – Coming soon!
Also check out their deprescribing/empower pamphlets to accompany these tools (and more)
Radiology recommendations and clinical decision rules [PDF] from Choosing Wisely Australia (for practitioners) has great algorithms to help patients avoid unnecessary imaging in acute ankle injury, DVT, Pulmonary Embolus, acute lower back pain, c-spine trauma, and head trauma.
XRayRisk: Radiation Risk Calculator [Website] from (for patients and practitioners) is a website that allows individuals to calculate their radiation exposure from a given test, such as a CT Abdomen or a Dental x-Ray. It will also show your baseline risk of developing cancer and how this is affected by the scan, plus it allows you to easily add up all the tests you've ever had to calculate the magnitude of your overall exposure.
RPA SDM Toolkit: [iOS] An App version of the Renal Physicians Association (RPA)'s Shared Decision Making Guideline. It offers nephrologists the tools and recommendations with which they can aid adult and pediatric patients who have AKI, CKD, or ESRD in initiating, withholding and withdrawing dialysis. LIMITATIONS: industry funding is taken by this organization and though not obvious, it may alter the quality of the tool
Obstructive Sleep Apnea (OSA) PriDecisionAid [Interactive website] from UBC. This decision aid is designed for adults recently diagnosed with obstructive sleep apnea (OSA). It provides information about OSA and treatment options.
NEW: Predict: Prostate Cancer Prognosis Tool: An individualized prognostic model for men newly diagnosed with non-metastatic prostate cancer from NHS. Can be used to discuss and understand harms and benefits of radical prostatectomy, radiation therapy, and conservative management.