Peering into the black box: A meta-analysis of how clinicians use decision aids during clinical encounters

Kirk D. Wyatt, Megan E. Branda, Ryan T. Anderson, Laurie J. Pencille, Victor M. Montori, Erik P. Hess, Henry H. Ting, Annie LeBlanc

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Objective: To quantify the extent to which clinicians use clinically-efficacious decision aids as intended during implementation in practice and how fidelity to usage instructions correlates with shared decision making (SDM) outcomes. Methods: Participant-level meta-analysis including six practice-based randomized controlled trials of SDM in various clinical settings encompassing a range of decisions.Results: Of 339 encounters in the SDM intervention arm of the trials, 229 were video recorded and available for analysis. The mean proportion of fidelity items observed in each encounter was 58.4% (SD = 23.2). The proportion of fidelity items observed was significantly associated with patient knowledge (p = 0.01) and clinician involvement of the patient in decision making (p <0.0001), while no association was found with patient decisional conflict or satisfaction with the encounter.Conclusion: Clinicians' fidelity to usage instructions of point-of-care decision aids in randomized trials was suboptimal during their initial implementation in practice, which may have underestimated the potential efficacy of decision aids when used as intended.

Original languageEnglish (US)
Article number26
JournalImplementation Science
Issue number1
StatePublished - Feb 22 2014


  • Decision aids
  • Fidelity
  • Meta-analysis
  • Patient involvement
  • Patient-centered care
  • Shared decision making

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Peering into the black box: A meta-analysis of how clinicians use decision aids during clinical encounters'. Together they form a unique fingerprint.

Cite this