Assuring quality of patient decision aids
The IPDAS Story
2003-2013
Dawn Stacey RN, PhD
Research Chair in Knowledge Translation to Patients
Full Professor, School of Nursing
Director of the Patient Decision Aids Research Group
Scientist, Ottawa Hospital Research Institute
International Patient
Decision Aid Standards
To enhance the quality and effectiveness of patient
decision aids by establishing a shared evidenceinformed framework for improving their content,
development, implementation, and evaluation.
IPDAS Steering Committee: Glyn Elwyn & Dawn Stacey (Co-Leads),
M Barry, N Col, A Coulter, K Eden, M Härter, M Holmes-Rovner,
H Llewellyn-Thomas, V Montori, N Moumjid, M Pignone,
R Thomson, L Trevena, R Volk, T van der Weijden
IPDAS Phases
2003-2006 Developing the Checklist (modified Delphi
process)
2006-2009 Developing the Instrument (psychometric
evaluation)
2009-2013 Agreeing Minimal Standards (modified Delphi
process)
2011-2013 Updating evidence underlying
the IPDAS checklist (knowledge synthesis)
International Patient Decision Aids
Standards Collaboration (IPDAS)
Objective:
To establish internationally approved criteria to determine the
quality of patient decision aids. These criteria are helpful to
individuals and organizations that use and/or develop patient
decision aids:
– Patients
– Practitioners
– Developers
– Researchers
– Policy makers or payers
>100 participants
from 14 countries
To learn more, visit: ipdas.ohri.ca
Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462
International Patient Decision Aids
Standards Collaboration Quality Criteria
12 Dimensions
Essential Content
Generic Criteria
– Development process
–
Information
– Disclosure
–
Probabilities
– Internet delivery
–
Values clarification
–
– Balance
Guidance
–
Patient Stories
Effectiveness Criteria
–
Decision process
–
Decision quality
– Plain language
– Up to date evidence
Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417.
http://www.ncbi.nlm.nih.gov/pubmed/16908462
International Patient Decision Aid Standards
(IPDAS) presenting probabilities
The patient decision aid presents probabilities …
No
Yes
1.…using event rates…
2. …using the same denominator
3. …over the same period of time
4. …with uncertainty
5. …using visual diagrams (e.g. faces, bar charts)
6. …using the same scales
7. …with more than 1 way of viewing probabilities (e.g.
words, numbers, diagrams).
8. …based on patient’s own situation (e.g. specific to their
age or severity of their disease)
9. …using both positive and negative frames
(Elwyn et al., (2006) in BMJ 333(7565):417; Trevena et al. (2006) in J Eval Clin Practice)
Prostate Cancer
Knowing Your Options: A Decision Aid for Men With Clinically Localized Prostate Cancer
Agency for Healthcare Research and Quality (AHRQ)
Localised prostate cancer - low risk
Option Grid Collaborative
IPDAS Phases
2003-2006 Developing the Checklist
2006-2009 Developing the Instrument
2009-2013 Agreeing Minimal Standards
2011-2013 Updating evidence underlying
the IPDAS checklist
IPDASi uses a 4-point scale with items
descriptors (strongly agree to strongly disagree)
Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269
IPDAS Phases
2003-2006 Developing the Checklist
2006-2009 Developing the Instrument
2009-2013 Agreeing Minimal Standards
2011-2013 Updating evidence underlying
the IPDAS checklist
IPDAS v4.0
Items across the 3 Categories
Dimensions
Information
Probabilities
Values
Guidance
Development
Evidence
Disclosure
Plain Language
Evaluation
Test
Totals
# of Criteria / Category
Qualifying
Certification
Quality
5
1
2
6
1
2
6
2
1
1
2
5
28
1
4
1
6
4
10
Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501
Summary of qualifying criteria
1. describes the health condition or problem
2. explicitly states the decision that needs to be considered
3. describes the options available
4. describes the positive features
5. describes the negative features
6. describes what it is like to experience the consequences
Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501
Summary of certifying criteria
1. equal detail for negative and positive features of options
2. citations to the evidence
3. production or publication date
4. update policy
5. information about uncertainty around probabilities
6. funding source used for development
For screening decision aids
7.
8.
9.
10.
describes what the test is designed to measure
next steps after positive test result
next steps after negative test result
consequences of detecting a benign condition
Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501
IPDAS Phases
2003-2006 Developing the Checklist
2006-2009 Developing the Instrument
2009-2013 Agreeing Minimal Standards
2011-2013 Updating evidence underlying
the IPDAS checklist
2013 Peer-reviewed Publications for
IPDAS Collaboration’s Quality
Dimensions
BMC Medical Informatics and Decision Making 2013, 13(Suppl 2).
http://www.biomedcentral.com/bmcmedinformdecismak/supplements/13/S2
Proposed National Certification Process
for patient decision aids
1. Setting criteria for certification – IPDAS
2. Assessing content
3. Certifying every decision aid or certifyign
producer processes
4. Establishing new entity or new function for
existing entity (e.g. in the US - National Quality
Forum; National Committee for Quality Assurance)
Alston et al., 2014 Shared Decision-Making Strategies for Best Care: Patient
Decision Aids and Beyond. IOM Discussion Paper
http://ipdas.ohri.ca