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Review
. 2021 Nov 8;11(11):CD013385.
doi: 10.1002/14651858.CD013385.pub2.

Decision coaching for people making healthcare decisions

Janet Jull  1 , Sascha Köpke  2 , Maureen Smith  3 , Meg Carley  4 , Jeanette Finderup  5   6   7 , Anne C Rahn  8 , Laura Boland  9   10 , Sandra Dunn  11 , Andrew A Dwyer  12   13 , Jürgen Kasper  14 , Simone Maria Kienlin  15   16 , France Légaré  17 , Krystina B Lewis  18   19 , Anne Lyddiatt  20 , Claudia Rutherford  21   22 , Junqiang Zhao  18 , Tamara Rader  23 , Ian D Graham  4   24 , Dawn Stacey  18
Affiliations
Review

Decision coaching for people making healthcare decisions

Janet Jull et al. Cochrane Database Syst Rev. .

Abstract

Background: Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching.

Objectives: To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects.

Search methods: We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021.

Selection criteria: We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions.

Data collection and analysis: Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence.

Main results: Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low.

Authors' conclusions: Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.

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Conflict of interest statement

Janet Jull: none known

Sascha Köpke (SKo): Co‐authorship of one included study

Maureen Smith: receives honoraria from the Ontario Ministry of Health to attend meetings, has received travel scholarships to attend conferences as a consumer, and receives an honorarium for roles as a co‐investigator and a knowledge user on two Canadian Institutes of Health Research grants.

Meg Carley: none known

Jeanette Finderup: none known

Anne C Rahn: Co‐authorship of one included study

Laura Boland: none known

Sandra Dunn: none known

Andrew Dwyer: is an Assistant Professor of Nursing at Boston College whose research focusses on developing more person‐centered approaches to care. He receives funding from Boston College and the U.S. National Institutes of Health (U.S.A.) and receives funding to cover travel expenses for his faculty participation in a Swiss rare diseases summer school. Dr. Dwyer has no competing interests to declare.

Jürgen Kasper: Co‐authorship of one included study

Simone Maria Kienlin (SKi): none known

France Légaré: none known

Krystina B Lewis: none known

Anne Lyddiatt: none known

Claudia Rutherford: none known

Jungqiang Zhao: none known

Tamara Rader: none known

Ian D Graham: none known

Dawn Stacey: is a Professor in the School of Nursing at the University of Ottawa and Senior Scientist at the Ottawa Hospital Research Institute where she conducts funded studies to evaluate the effectiveness of patient decision aids and decision coaching. The institution where she is employed, the University of Ottawa, has received funding to support her research studies from national granting agencies and cancer programmes. She has received funding for consultation with the Washington State Health Care Authority for the development and implementation of criteria for certifying patient decision aids. Finally, she received funding to travel for the Shared Decision Making Advisory Board Meeting in Vejle, Denmark, working with Safer Care Victoria in Melbourne, Australia, meetings and training for the Joint Commission of Taiwan.

Figures

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1
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1.1
1.1. Analysis
Comparison 1: Comparison #1: Decision coaching versus usual care, Outcome 1: Decision self‐confidence
1.2
1.2. Analysis
Comparison 1: Comparison #1: Decision coaching versus usual care, Outcome 2: Knowledge
2.1
2.1. Analysis
Comparison 2: Comparison #2: Decision coaching versus evidence‐based information, Outcome 1: Knowledge
3.1
3.1. Analysis
Comparison 3: Comparison #3: Decision coaching plus evidence‐based information versus usual care, Outcome 1: Uninformed subscale ‐ Decisional conflict
3.2
3.2. Analysis
Comparison 3: Comparison #3: Decision coaching plus evidence‐based information versus usual care, Outcome 2: Unclear values ‐ Decisional conflict
3.3
3.3. Analysis
Comparison 3: Comparison #3: Decision coaching plus evidence‐based information versus usual care, Outcome 3: Feeling Unsupported ‐ Decisional conflict
3.4
3.4. Analysis
Comparison 3: Comparison #3: Decision coaching plus evidence‐based information versus usual care, Outcome 4: Knowledge
4.1
4.1. Analysis
Comparison 4: Comparison #4: Decision coaching plus evidence‐based information versus evidence‐based information, Outcome 1: Knowledge
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Fischer 2006 {published data only}
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Giordano 2012 {published data only}
    1. Giordano L, Stefanini V, Senore C, Frigerio A, Castagno R, Marra V, et al. The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years. European Journal of Public Health 2012;22(3):413-8. - PubMed
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    1. Green MJ, Peterson SK, Baker MW, Friedman LC, Harper GR, Rubinstein WS, et al. Use of an educational computer program before genetic counseling for breast cancer susceptibility: effects on duration and content of counseling sessions. Genetics in Medicine 2005;7(4):221-9. - PMC - PubMed
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    1. Green MJ, Van Scoy LJ, Foy AJ, Stewart RR, Sampath R, Schubart JR, et al. A randomized controlled trial of strategies to improve family members' preparedness for surrogate decision-making. American Journal of Hospice and Palliative Medicine 2018;35(6):866-74. - PMC - PubMed
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    1. Hamann J, Maris N, Iosifidou P, Mendel R, Cohen R, Wolf P, et al. Effects of a question prompt sheet on active patient behaviour: a randomized controlled trial with depressed outpatients. International Journal of Social Psychiatry 2014;60(3):227-35. - PubMed
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Legare 2003 {published data only}
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Levi 2017 {published data only}
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Liao 2016 {published data only}
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Liberatore 2003 {published data only}
    1. Liberatore MJ, Myers RE, Nydick RL, Steinberg M, Brown ER, Gay R, et al. Decision counseling for men considering prostate cancer screening. Computers & Operations Research 2003;30(10):1421-34.
Lurie 2011 {published data only}
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Manchanda 2016 {published data only}
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Massey 2016 {published data only}
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McIlvennan 2018 {published data only}
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Metz 2019 {published data only}
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Miller 2005b {published data only}
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Minneci 2019 {published data only}
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Mino 2020 {published data only}
    1. Mino MF, Paz Y, Martinez-Portilla RJ, Pauta M, Borrell A. OC11.03: a randomised controlled trial on the influence of extensive prenatal counselling on the attitudes and preferences towards first-line prenatal testing for fetal aneuploidy detection (INVASIVE). Ultrasound in Obstetrics & Gynecology 2020;56:32.
Mohamed 2018 {published data only}
    1. Mohamed N, Leung TM, Mehrazin R, Sfakianos J, Knauer C. An intervention to improve bladder cancer knowledge and treatment decision making in patients with muscle invasive bladder cancer: a pilot study. Journal of Urology 2018;199 (4 Suppl 1):e310-11.
Moudi 2020 {published data only}
    1. Moudi Z, Ansari H, Umarzeh M. Effect of the REDI counselling approach on the use of modern postpartum contraceptive methods among adolescent mothers in Iran. Africa Journal of Nursing and Midwifery 2020;22(2):1-19.
Murray 2004 {published data only}
    1. Murray S, Shetty A, Rattray A, Taylor V, Bhattacharya S. A randomized comparison of alternative methods of information provision on the acceptability of elective single embryo transfer. Human Reproduction (Oxford, England) 2004;19(4):911-6. - PubMed
Myers 2012 {published data only}
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Myers 2019 {published data only}
    1. Myers RE, Stello B, Daskalakis C, Sifri R, González ET, DiCarlo M, et al. Decision support and navigation to increase colorectal cancer screening among Hispanic patients. Cancer Epidemiology, Biomarkers & Prevention 2019;28(2):384-91. - PubMed
NCT00262899 {published data only}
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Nichol 1992 {published data only}
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Nosratabadi 2018 {published data only}
    1. Nosratabadi M, Hekmat K, Dencker A, Abbaspoor Z. Individual and group psycho-educational counseling on knowledge, attitude and preference for birth method in nulliparous women: a randomized controlled trial. Journal of Family and Reproductive Health 2018;12(2):103-10. - PMC - PubMed
O'Cathain 2002 {published data only}
    1. O'Cathain A, Walters S, Thomas K, Kirkham M. Use of evidence based leaflets to promote informed choice in maternity care: randomized controlled trial in everyday practice. BMJ (Clinical Research Edition) 2002;324:643. - PMC - PubMed
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Omer 2007 {published data only}
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Parapiboon 2020 {published data only}
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Pearson 2020 {published data only}
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Pendley 2018 {published data only}
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Penson 2011 {published data only}
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Peralta 2020 {published data only}
    1. Peralta CA, Livaudais-Toman J, Stebbins M, Lo L, Robinson A, Pathak S, et al. Electronic decision support for management of CKD in primary care: a pragmatic randomized trial. American Journal of Kidney Diseases 2020;76(5):636-44. - PMC - PubMed
Perestelo‐Perez 2017 {published data only}
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Pieterse 2005 {published data only}
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Rahn 2014 {published data only}
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Rahn 2016 {published data only}
    1. Rahn AC, Kopke S, Backhus I, Kasper J, Krutzelmann A, Kleiter I, et al. Decision coaching in multiple sclerosis (DECIMS) - pilot randomised controlled trial and process evaluation. Multiple Sclerosis 2016;22 Suppl 3:681-2.
Rahn 2019 {published data only}
    1. Rahn AC, Kopke S, Barabasch A, Heesen C. Nurse-led immunotreatment decision coaching in people with multiple sclerosis (DECIMS) - cluster randomised controlled trial and process evaluation (ISRCTN37929939). Multiple Sclerosis Journal 2019;25 Suppl 2:575-6. - PubMed
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Roussi 2010 {published data only}
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Schroy 2012 {published data only}
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Schubart 2019 {published data only}
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Schwartz 2014 {published data only}
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Sepucha 2002 {published data only}
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Shelin 2019 {published data only}
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Sheridan 2011 {published data only}
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Sheridan 2014 {published data only}
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Sweet 2014 {published data only}
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Swoboda 2016 {published data only}
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Swoboda 2017 {published data only}
    1. Swoboda CM, Miller CK, Wills CE. Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes. Patient Education and Counseling 2017;100(7):1367-73. - PubMed
Talen 2011 {published data only}
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Tea 2018 {published data only}
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Thomas 2013 {published data only}
    1. Thomas KL, Zimmer LO, Dai D, Al-Khatib SM, Allen LaPointe NM, Peterson ED. Educational videos to reduce racial disparities in ICD therapy via innovative designs (VIVID): a randomized clinical trial. American Heart Journal 2013;166(1):157-63. - PubMed
Thomson 2007 {published data only}
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Van Peperstraten 2011 {published data only}
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Van Roosmalen 2004 {published data only}
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    1. Van Tol-Geerdink JJ, Willem Leer J, Weijerman PC, Van Oort IM, Vergunst H, Van Lin EN, et al. Choice between prostatectomy and radiotherapy when men are eligible for both: a randomized controlled trial of usual care vs decision aid. BJU International 2013;111(4):564‐73. - PubMed
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Voepel‐Lewis 2020 {published data only}
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    1. Waterman A, Peipert J, McSorley AM, Goalby C, Peace L. At-home transplant education increases black and low-income dialysis patients' transplant knowledge, attitudes, informed decision-making, and pursuit: an explore transplant @ home randomized controlled trial. American Journal of Transplantation 2017;13 Suppl 3:381.
Waterman 2018a {published data only}
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Waterman 2018b {published data only}
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Waterman 2019 {published data only}
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Wensaas 2014 {published data only}
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Wenzel 2019 {published data only}
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Westermann 2013 {published data only}
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Wevers 2014 {published data only}
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Wilkie 2020 {published data only}
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References to studies awaiting assessment

Hadizadeh‐Talasaz 2021 {published data only}
    1. Hadizadeh-Talasaz F, Ghoreyshi F, Mohammadzadeh F, Rahmani R. Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial. BMC Pregnancy and Childbirth 2021;21(1):144. [DOI: 10.1186/s12884-021-03615-w] - DOI - PMC - PubMed
Perfors 2021 {published data only}
    1. Perfors IAA, Noteboom EA, De Wit NJ, Van der Wall E, Visserman EA, Van Dalen T, et al. Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: time out with the general practitioner and cancer treatment decision. Psycho-Oncology 2021;30(4):571-80. [DOI: 10.1002/pon.5604] - DOI - PMC - PubMed
Wagner 2021 {published data only}
    1. Wagner GJ, Wanyenze RK, Beyeza-Kashesya J, Gwokyalya V, Hurley E, Mindry D, et al. "Our Choice" improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches. Implementation Science 2021;16(1):41. [DOI: 10.1186/s13012-021-01109-z] - DOI - PMC - PubMed
Wang 2021 {published data only}
    1. Wang TJ, Chiu PP, Chen KK, Hung LP. Efficacy of a decision support intervention for reducing decisional conflict in patients with elevated serum prostate-specific antigen: a randomized controlled trial. European Journal of Oncology Nursing 2021;50:101865. [DOI: 10.1016/j.ejon.2020.101865] - DOI - PubMed

References to ongoing studies

Chambers 2008 {published data only}
    1. Chambers SK, Ferguson M, Gardiner RA, Nicol D, Gordon L, Occhipinti S, et al. ProsCan for men: randomised controlled trial of a decision support intervention for men with localised prostate cancer. BMC Cancer 2008;8:207. [DOI: 10.1186/1471-2407-8-207] - DOI - PMC - PubMed
DRKS00015527 {published data only}
    1. DRKS00015527. Evaluation of a decision coaching program for structured decision support in preference sensitive decisions of risk-adapted prevention for BRCA1/2 gene mutation carriers (EDCP-BRCA). www.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015527 (first received October 30, 2019).
IRCT2017100231117N5 {published data only}
    1. IRCT2017100231117N5. Effect of crisis counseling on anxiety, decision-making style and strategies in women with unplanned pregnancy. www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2017100231117N5 (first received November 11, 2017).
IRCT20200105046014N1 {published data only}
    1. IRCT20200105046014N1. The effect of individual counseling on the intention to choose. www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20200105046014N1 (first received February 22, 2020).
Karra 2021 {published data only}
    1. Karra M, Zhang K. User-centered counseling and male involvement in contraceptive decision making: protocol for a randomized controlled trial. Journal of Medical Internet Research, Research Protocols 2021;10(4):e24884. [DOI: 10.2196/24884] - DOI - PMC - PubMed
Makarov 2021 {published data only}
    1. Makarov DV, Feuer Z, Ciprut S, Lopez NM, Fagerlin A, Shedlin M, et al. Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers. Trials 2021;22(1):128. [DOI: 10.1186/s13063-021-05064-4] - DOI - PMC - PubMed
NCT00685256 {published data only}
    1. NCT00685256. Standard genetic counseling with or without a decision guide in improving communication between mothers undergoing BRCA1/2 testing and their minor-age children. clinicaltrials.gov/ct2/show/record/NCT00685256 (first received May 24, 2008).
NCT01263678 {published data only}
    1. NCT01263678. Helping patients with spinal stenosis make a treatment decision: a randomized study assessing the benefits of health coaching. clinicaltrials.gov/show/NCT01263678 (first received December 20, 2010).
NCT03956004 {published data only}
    1. NCT03956004. The impact of a technology-enabled decision aid, for patients with hip and knee osteoarthritis on decision quality, level of shared decision-making, patient satisfaction and magnitude of limitations. clinicaltrials.gov/ct2/show/record/NCT03956004 (first received May 17, 2019).
NCT04659005 {published data only}
    1. NCT04659005. Nurse-led decision counseling on hepatocellular carcinoma screening. clinicaltrials.gov/ct2/show/NCT04659005 (first received October 31, 2020).
Nelson 2020 {published data only}
    1. Nelson LE, Ajiboye W, Djiadeu P, Odhiambo AJ, Pedersen C, Ramos SR, et al. A web-based intervention to reduce decision conflict regarding HIV pre-exposure prophylaxis: protocol for a clinical trial. Journal of Medical Internet Research, Research Protocols 2020;9(6):e15080. [DOI: 10.2196/15080] - DOI - PMC - PubMed
Ockhuysen‐Vermey 2008 {published data only}
    1. Ockhuysen-Vermey CF, Henneman L, Van Asperen CJ, Oosterwijk JC, Menko FH, Timmermans DRM. Design of the BRISC study: a multicentre controlled clinical trial to optimize the communication of breast cancer risks in genetic counselling. BMC Cancer 2008;8:283. [DOI: 10.1186/1471-2407-8-283] - DOI - PMC - PubMed
Scalia 2019 {published data only}
    1. Scalia P, Durand MA, Forcino RC, Schubbe D, Barr PJ, O'Brien N, et al. Implementation of the uterine fibroids Option Grid patient decision aids across five organizational settings: a randomized stepped-wedge study protocol. Implementation Science 2019;14(1):88. [DOI: 10.1186/s13012-019-0933-z] - DOI - PMC - PubMed
Shirzad 2020 {published data only}
    1. Shirzad M, Shakibazadeh E, Rahimi Foroushani A, Abedini M, Poursharifi H, Babaei S. Effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing the mode of delivery in pregnant women: a study protocol for a randomized controlled trial. Trials 2020;21(1):970. [DOI: 10.1186/s13063-020-04865-3] - DOI - PMC - PubMed
TCTR20191226001 {published data only}
    1. TCTR20191226001. The effect of empowerment education on decisional conflict and attitude towards fertility and childbearing of women with a history of failed pregnancy. www.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20191226001 (first received October 3, 2019).
TCTR20200320002 {published data only}
    1. TCTR20200320002. Decisions of adolescent mothers toward using etonogestrel implant: comparison between the people that knowledge from Print Media in individual counseling and counseling from video-based group counseling. http://www.thaiclinicaltrials.org/show/TCTR20200320002 (first received March 7, 2020).

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