Patient education programmes and decision aids - evaluation of complex interventions

ABSTRACT

Patients have the right to make informed decisions on treatmentgoals and treatment regimens and also to be provided with reliableinformation necessary for decision-making. Evidence-based medicineexplicitly integrates patients” values and preferences in treatmentdecisions. Both are regarded as crucial to increase both thepatients” quality of care and independence. Education programmesor patient decision aids are complex interventions, typically comprisingseparate components acting interdependently (e.g. content,structure, and media of an education programme). They are heterogeneousin their goals, methods and target populations. Developmentand evaluation of complex interventions are sophisticatedprocesses requiring both qualitative and quantitative methods. In aprevious review we showed that common methodologies used insystematic reviews do not allow adequate appraisal of complex interventions.Patient education programmes were used as an example.The present review outlines present developments in patienteducation and shared decision making in diabetes care. It also comprisesan update of the previous review. Methodological challengesof the development and evaluation of complex interventions are discussed.Methods of current systematic reviews do still not meet thechallenges to appraise patient education and self-management programmes.Since these are complex and heterogeneous interventions,consideration of aggregated evidence is necessary. Informationnecessary for the evaluation of such programmes is difficult orimpossible to identify. In conclusion we propose to establish a scientificnetwork and database, which supports scientific exchange andsystematic tagging of self-management programmes, patient educationprogrammes and patient decision aids(AU)