Effects of patient decision aids used pre-consult or in-consult on patient-clinician communication - secondary analysis of a systematic review with meta-analysis

Patient decision aids (PtDAs) provide benefits and risks of options for a specific decision, and help patients clarify their values. This study examined whether the timing of PtDA use—before (pre-consult) or during (in-consult) the clinical encounter—affects patient-clinician communication. We conducted a secondary analysis of 209 randomized controlled trials (RCTs) in the 2024 Cochrane review of PtDAs compared to usual care. Eligible studies measured patient-clinician communication using observer-, patient- or clinician-reported instruments. Thirty-six RCTs met inclusion criteria, reporting on communication outcomes: 21 evaluated pre-consult PtDAs and 15 in-consult PtDAs. Pre-consult PtDAs commonly addressed screening and treatment decisions, often using digital formats. In-consult PtDAs focused on treatment and were mostly paper-based. For pre-consult PtDAs, 68.6% of patients discussed the decision with their clinician versus 50.2% in usual care (p < 0.001), though no difference was found for patient-reported SDM-Q-9 scores. In-consult PtDAs significantly improved communication measured by the observer-rated OPTION12 instrument. The effects of PtDAs varied by timing and measurement approach, with in-consult PtDAs potentially offering more structured support for shared decision making. No studies directly compared pre- and in-consult PtDAs. Future research should directly compare these approaches and use consistent communication measures.