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Intervention

Consumer Intervention: Facilitating communication and decision making

Definition

Strategies to involve consumers in decision making about medicines. Interventions include those that aim to help consumers make decisions about medicines use, such as interventions to encourage consumers to express their beliefs, values and preferences about treatments and care; and/or to optimise communication with consumers about medicines use and related issues.

Effectiveness

While some individual strategies are promising, the evidence on strategies to promote communication and/or decision making is mixed overall.

There is sufficient evidence that continuous labour support reduces the use of analgesia or anaesthesia, but not oxytocin use. Such support also reduces labour length, negative rating of birth experiences, numbers of instrumental vaginal and caesarean births whilst increasing rates of spontaneous vaginal birth without increasing postpartum reports of severe labour pain - it is generally effective.

There is some evidence that decision aids improve knowledge and treatment decision making (e.g. reducing decisional conflict) — they are generally effective. However, there is insufficient evidence of effects on adherence, treatment uptake or clinical outcomes — they are generally ineffective.

There is sufficient evidence that delayed prescribing as a specific decision making strategy is effective to decrease antibiotic use, but it also decreases satisfaction and has mixed effects on clinical outcomes and adverse events.

There is sufficient evidence that presenting hypothetical medication treatment effects as a relative risk reduction increases persuasiveness compared to absolute risk reduction or numbers needed to treat - it is generally effective. However persuasiveness is not improved when presented as absolute risk reduction compared to numbers to treat - it is generally ineffective. There is insufficient evidence to determine if presenting hypothetical vaccination treatment effects as relative risk reduction significantly increases satisfaction, persuasiveness or perceived efficacy of the vaccination compared to absolute risk reduction.

There was some evidence that tailored reminders and recall; home visits plus vaccination; offer of free vaccination; facilitators working with physicians and financial incentives to physicians all improve immunisation demand - they are generally effective. However, other postcard reminders had mixed effects and physician reminders alone were ineffective. The effectiveness of other forms of participant reminders and recall; group visits or home visits with vaccination encouragement or in combination with GP care plan as well as other physician reminders, or education feedback were all inconclusive. There is insufficient evidence to determine if positive framing of medication information is effective in persuading people about medication attributes/goals.
Evidence is also inconclusive on the effectiveness of pharmacy discharge planning, written action plans, the optimal monitoring strategy for antiretroviral therapy (e.g., virologic, immunologic and/or clinical monitoring), education and enhanced follow-up, or specialised care models to improve adherence, medicines use, knowledge, or clinical outcomes. Contract-based strategies are generally ineffective.

Summary of Overall Findings from Reviews

Summary of Findings Related to Prescribing

20 reviews of interventions with a focus to improve communication skills and/or decision making were identified, 16 of high quality.

One large review looking at decision aids across diseases (Stacey 2012) reported significantly better knowledge and decision making outcomes (indecision, decisional conflict, proportion of patients remaining undecided, risk perception accuracy) but few consistent changes to treatment uptake, adherence or clinical outcomes with decision aids. There were mixed outcomes for patient participation in decision making across patient- and practitioner-controlled decisions as well as for shared decisions.

Another large cross-disease review on adherence (Haynes 2008), including strategies to promote communication and decision making, reported mixed effects on adherence and clinical outcomes; while another on contract-based interventions reported inconsistent effects on adherence and other outcomes across treatments (Bosch-Capblanch 2007).

A review of continuous labour support reported reductions in analgesia or anaesthesia use, negative rating of birth experiences, labour length, numbers of instrumental vaginal and caesarean births. Such support increased spontaneous vaginal births without increasing postpartum reports of severe labour pain; however, the use of synthetic oxytocin during labour and perineal trauma were not significantly changed (Hodnett 2011).

In a review of immunisation demand or uptake interventions, tailored reminders and recall; home visits plus vaccination; offers of free vaccination; facilitators working with physicians and financial incentives to physicians all were promising. Other forms of participant and physician reminders, education and feedback recall or participant group programs had mixed effects (Thomas 2010).

A review of statistical formats for presenting risks reported that relative risk reduction presentations of vaccination treatment effects may significantly increase persuasiveness and satisfaction but not the perceived efficacy of the vaccination compared to absolute risk reduction. Presenting medication treatment effects as a relative risk reduction significantly increased understanding, persuasiveness and the consistency of decision with values compared to absolute risk reduction or numbers needed to treat. Presenting medication treatment effects as an absolute risk reduction may increase understanding but does not significantly change persuasiveness compared to numbers needed to treat (Akl 2011). Positive framing of information about medications had mixed effects on persuasiveness of messages about medication (Akl 2011). Delayed antibiotic prescribing significantly reduced antibiotic use but decreased satisfaction, and had mixed effects on clinical outcomes, adverse effects and supplementary medicines use (Spurling 2007).

Other disease-specific reviews with a communication or decision making support component included in written individual parenting training for intellectually disabled parents, action plans, pharmacy discharge planning, optimal antiretroviral therapy monitoring strategies, education and enhanced follow-up or specialised care models reported inconclusive effects on adherence, medicines use, clinical outcomes, knowledge and satisfaction (Bhogal 2006, Bradley 2008, Shepperd 2010, Chang 2010, Halpern 2011, Tapp 2007, Coren 2011).

Reviews listed as "Summary Pending" will be analyzed, summarized and reported at a later date.

The findings will then be incorporated in the overall evidence summaries of the interventions they address.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Bhogal S, Zemek R, Ducharme FM. Written action plans for asthma in children. Cochrane Database of Systematic Reviews 2006 3:CD005306. 11 (High)
Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schünemann H. Framing of health information messages. Cochrane Database of Systematic Reviews 2011 12:CD006777. 10 (High)
Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schünemann H. Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database of Systematic Reviews 2011 3:CD006776. 10 (High)
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008 2:CD000011. 10 (High)
McIntosh AM, Conlon L, Lawrie SM, Stanfield AC. Compliance therapy for schizophrenia. Cochrane Database of Systematic Reviews 2006 3:CD00344. 10 (High)
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Legare F, Thomson R. Decision aids for people facing health treatment or screening decisions (update). Cochrane Database of Systematic Reviews 2011 10:CD001431. 10 (High)
Thomas RE, Russell M, Lorenzetti D. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database of Systematic Reviews 2010 9:CD005188. 10 (High)
Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007 2:CD004808. 9 (High)
Bradley PM, Lindsay B. Care delivery and self-management strategies for adults with epilepsy. Cochrane Database of Systematic Reviews 2008 1:CD006244. 9 (High)
Chang L, Harris J, Humphreys E. Optimal monitoring strategies for guiding when to switch first-line antiretroviral therapy regimens for treatment failure in adults and adolescents living with HIV in low-resource settings. Cochrane Database of Systematic Reviews 2010 4:CD008494. 9 (High)
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2011 2:CD003766. 9 (High)
Shepperd S, McClaran J, Phillips C, Lannin N, Clemson L, McCluskey A, Cameron I, Barras S. Discharge planning from hospital to home. Cochrane Database of Systematic Reviews 2010 1:CD000313. 9 (High)
Spurling GK, Del Mar CB, Dooley L, Foxlee R. Delayed antibiotics for respiratory infections. Cochrane Database of Systematic Reviews 2007 3:CD004417. 9 (High)
Tapp S, Lasserson TJ, Rowe B. Education interventions for adults who attend the emergency room for acute asthma. Cochrane Database of Systematic Reviews 2007 3:CD003000. 9 (High)
Coren E, Hutchfield J, Thomae M, Gustafsson C. Parent training support for intellectually disabled parents. Cochrane Database of Systematic Reviews 2010 6:CD007987. 8 (High)
Halpern V, Lopez LM, Grimes DA, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods of contraception. Cochrane Database of Systematic Reviews 2011 4:CD004317. 8 (High)
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E, Tant E, Wallace I, Viswanathan M. Health literacy interventions and outcomes: an updated systematic review. Evidence Report/Technology Assessment 2011 (199):1-941. 7 (Medium)
Roughead EE, Semple SJ, Vitry AI. Pharmaceutical care services: A systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes. International Journal of Pharmacy Practice 2005 13 (1):53-70. 7 (Medium)
Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expectations 2004 7 (3):235-45. 5 (Medium)
Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. The American Journal of Psychiatry 2002 159 (10):1653-64. 4 (Medium)
El-Gayar O, Timsina P, Nawar N, Eid W. A systematic review of IT for diabetes self-management: are we there yet? International Journal of Medical Informatics 2013 82 (8):637-652. Summary Pending
Halpern V, Lopez LM, Grimes DA, Stockton LL, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods of contraception. Cochrane Database of Systematic Reviews 2013 10:CD004317. Summary Pending
Harun A, Harrison JD, Young JM. Interventions to improve patient participation in the treatment process for culturally and linguistically diverse people with cancer: a systematic review. Asia-Pacific Journal of Clinical Oncology 2013 9 (2):99-109. Summary Pending