OBJECTIVES:

Shared decision making (SDM) and decision aids (DAs) have been shown to improve clinical outcomes and decrease decisional conflict (DC) in some therapeutic areas. Their impact is less understood among pain patients. The aim of this study was: to assess the impact of SDM and/or DAs on DC, measured using Decisional Conflict Scale (DCS), among patients with pain; to conduct a feasibility assessment of a meta-analysis estimating this impact in patients suffering with pain.

METHODS:

This feasibility study was a meta-analysis of studies identified via a systematic review of the PubMed database, using detailed PICOS criteria. English-language studies were included if they: were analytical/comparative, included SDM/DAs and standard of care (SOC), and reported DCS outcomes for patients with pain. Forest plot was constructed to pool findings. Publication bias and heterogeneity were assessed. Random effects model was used to account for heterogeneity, and the findings were compared to a fixed effects model. Comprehensive Meta-Analysis software was used for analysis.

RESULTS:

Of the 582 records screened, 6 studies were included in the quantitative synthesis using a random effects model. Studies were randomized (n=6); included chest pain (n=2), low back pain (n=2), fibromyalgia (n=1), labor pain (n=1); conducted in US (n=2), Germany (n=2), Australia (n=1); and compared SDM/DA with SOC. Random effects model did not yield a significant decrease in DC in the SDM group compared to SOC, -0.55 (95%CI -1.37 to 0.268; p = 0.188). Fixed effects model yielded a statistically significant result (-0.233 [95% CI -0.316 to -0.150; p= 0.0]), in comparison.

CONCLUSIONS:

This study did not detect a significant decrease in DC in the SDM group compared to SOC in patients with pain. This may be attributed to variability among studies. Future work will focus on an expanded meta-analysis(es), including comprehensive measures and databases, to assess the impact of SDM in this population.