Appraising the quality of patient decision aids for brain and heart health: An environmental scan with a health equity lens

<h2>Abstract</h2><h3>Background</h3> New brain-heart clinical practice guidelines recommend patient decision aids (PtDAs) to support people with or at risk of brain and heart conditions. We aimed to identify and appraise the quality of PtDAs addressing brain-heart conditions and their consideration of health equity. <h3>Methods</h3> We conducted an online environmental scan to identify publicly available PtDAs. Two reviewers independently searched, extracted data, and appraised their quality using International Patient Decision Aid Standards (IPDAS) criteria, Patient Education Materials Assessment Tool (PEMAT), and PROGRESS-Plus framework for health equity. <h3>Results</h3> Of 2549 resources identified, 51 PtDAs were eligible. Nine addressed a combined brain-heart decision, 36 primarily addressed cardiovascular conditions with brain implications, and 6 primarily addressed brain conditions with heart implications. Few focused on brain-heart conditions concomitantly. None addressed dementia, and only one addressed depression as a primary condition with cardiovascular risk addressed as a secondary consideration. Mean IPDAS essential criteria score was 5.8/7 (SD 1.5, range 1-7). For PEMAT-P (for printable materials), 91% PtDAs achieved adequate understandability rating (≥70%) and 56% achieved adequate actionability rating (≥70%). The most frequently reported PROGRESS-Plus healthy equity items were age (80%), gender/sex (45%) and socioeconomic status (39%). <h3>Conclusion</h3> Brain-heart guidelines recommend PtDA use, but our environmental scan highlighted the need for more of these important interventions. Few PtDAs focused on brain and heart conditions concomitantly, none addressed dementia and only one addressed depression, which frequently co-exist with cardiac conditions. PtDAs also lacked actionable guidance within an equity-informed framework to support quality decisions and decision-making processes for all.