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A Systematic Review of Decision Aids in Patients with Cardiovascular Disease
Based on IPDAS 4.0

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1
Z. Pei, X. Kang, and X. Zhang 1
1
Chinese Academy of Medical Sciences and Peking Union Medical College, China

Background: Cardiovascular disease is a leading cause of death worldwide, imposing a heavy medical
and economic burden on patients, families, and society. The medical process is variable and complex, and
patients’ choices about diagnosis and treatment are often influenced by factors such as age, education,
and disease severity. Patient decision aids are evidence-based tools that provide information about the
risks of treatment options to help patients consider and clarify their values and preferences, participate in
the decision-making process, and make informed choices. While the number and types of patient decision
aids are increasing, the quality has not received sufficient attention from researchers.

Objective: To evaluate the quality and effectiveness of decision aids in patients with cardiovascular disease.

Methods: Randomised controlled trials were systematically searched in databases including PubMed,
Oral Presentation Abstracts
Embase, Web of Science, and the Cochrane Library. Screening, data extraction, and risk of bias
assessment were performed independently and in duplicate. The International Patient Decision Aid
Standards 4.0 was used to assess the quality, and RevMan 5.4 software was used for meta-analysis.

Results: A total of 18 studies involving 5,247 patients were included in the analysis. Meta-analysis
showed that decision aids can improve patient knowledge (SMD=0.70, 95% CI 0.63-0.77, p<0.01) and
reduce patient decisional conflict (SMD=-0.23, 95% CI -0.28 to -0.17, p<0.01) in aspects such as being
informed (SMD=-0.36, 95% CI -0.48 to -0.25, p<0.01), clarity of values (SMD=-0.24, 95% CI -0.35 to -0.13,
p<0.01), receiving support (SMD=-0.19, 95% CI -0.31 to -0.08, p<0.01), and making effective decisions
(SMD=-0.19, 95% CI -0.30 to -0.08, p<0.01), thereby improving satisfaction with decision-making.

Conclusion: Patient decision aids have a significant effect on reducing decision conflict, increasing
decision satisfaction, and improving knowledge, but not on decision regret. Future research should
focus on developing patient decision aids that adhere to the International Patient Decision Aid
Standards 4.0 to promote shared decision-making.

Keywords: shared decision-making, cardiovascular disease, International Patient Decision Aid Standards,
decisional conflict, systematic review

_____________________________________________________________________________________________________
Correspondence: Xiaofeng Kang, Chinese Academy of Medical Sciences and Peking Union Medical
College, China
E-mail: xiaofengkang@nursing.pumc.edu.cn

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