Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas
Hoffman, AS and Volk, RJ and Saarimaki, A and Stirling, C and Li, LC and Marter, M and Kamath, GR and Llewellyn-Thomas, H, Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas, BMC Medical Informatics and Decision Making, 13, (S2) Article S13. ISSN 1472-6947 (2013) [Refereed Article]
Background: In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality
dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on
the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid.
Building on the original background chapter, this paper provides an updated definition for this dimension, outlines
a theoretical rationale, describes current evidence, and discusses emerging research areas.
Methods: An international, multidisciplinary panel of authors examined the relevant theoretical literature and
empirical evidence through 2012.
Results: The updated definition distinguishes Internet-delivery of patient decision aids from online health
information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication,
and education support the value of Internet features for providing interactive information and deliberative support.
Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly
updated), to the right person (tailored), at the right time (the appropriate point in the decision making process).
Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology
perspectives, such as consumer health informatics, user experience design, and human-computer interaction.
Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health
information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the
86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four
studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused
on identifying gaps in the empirical evidence base and identifying emerging areas of research.
Conclusions: As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to
delivering patient decision aids on the Internet. However, additional research is needed to identify best practices
and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of
interactivity, multimedia components, socially-generated information, and implementation strategies.
patient decision aids, internet, technology, information