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Patient decision aids (PDAs)

Learn about patient decision aids: what they are and how to use them.

What are patient decision aids (PDAs)?

PDAs are tools that help patients and providers talk together about care options. PDAs help patients understand their choices about whether to have a specific treatment or screening. This includes knowing the pros and cons of each available option.  

PDAs also provide patients with information needed to make a decision, based on their personal values and preferences, by exploring each option and how it relates to their values. For example, a PDA could help a pregnant woman decide whether to attempt a natural birth after having a cesarean.

Research shows that PDAs lead to increased knowledge and a more accurate understanding of risk. When using a PDA, more patients feel comfortable with the decisions they make and the care they receive.

How does the Health Care Authority (HCA) ensure the quality of PDAs?

Washington State law supports and regulates shared decision making and the certification of PDAs. In addition, Washington is the only state in the nation to certify PDAs. HCA began accepting PDAs for certification in April 2016.

What PDAs has HCA certified?

PDA Organization Audience Description

Amniocentesis test for chromosome problems: yes or no?

EBSCO Publishing

For women in week 15 of their pregnancy or later considering whether or not to have amniocentesis test

Addresses the question of whether or not to have an amniocentesis test for chromosome-related abnormalities.

Down Syndrome screening test: yes or no?

EBSCO Publishing

Women between 9 and 22 weeks of pregnancy

Addresses the question of whether or not to undergo prenatal screening tests for Down syndrome and other chromosomal conditions.

Pregnancy: birth options if your baby is getting too big

Healthwise, 800-706-9646

Healthy pregnant women who are carrying babies that may be big.

Helps women decide whether to wait for labor to start on its own or to induce labor when estimates suggest that the baby may be getting big. May not be appropriate in the case of a medical problem that could require early delivery or cesarean delivery.

Pregnancy: your birth options after cesarean

Healthwise, 800-706-9646

Women who have had a previous cesarean delivery.

Helps pregnant women who have had a previous cesarean delivery decide whether to schedule a repeat C-section or to attempt a trial of labor with the goal of having a vaginal delivery. A trial of labor and vaginal birth may not be an option for some women.

Prenatal genetic testing: Understanding your options Emmi Solutions Women before conception or early in the first trimester. Educates patients about prenatal genetic testing options.
PDA Organization Audience Description

Treatment choices for hip osteoarthritis

Health Dialog Services Corporation

People facing choices about surgical and nonsurgical approaches to managing hip osteoarthritis, including hip replacement surgery.

For people who have hip osteoarthritis and are considering nonsurgical or surgical treatment for pain, stiffness, limited motion, or other symptoms that are causing difficulty with everyday activities or a reduction in quality of life.

Treatment choices for knee osteoarthritis

Health Dialog Services Corporation

People facing choices about surgical and nonsurgical approaches to managing knee osteoarthritis, including knee replacement surgery.

For people who have knee osteoarthritis and are considering nonsurgical or surgical treatment for pain, stiffness, limited motion, or other symptoms that are causing difficulty with everyday activities or a reduction in quality of life.

Hip osteoarthritis: is it time to think about surgery?

Healthwise, 800-706-9646

People who have hip osteoarthritis that is causing pain and stiffness and impacting their activities and quality of life to some degree.

Focuses on the question of whether to have hip replacement surgery or to use nonsurgical treatments (in any combination) to reduce pain and improve function in patients with osteoarthritis of the hip.

Knee osteoarthritis: is it time to think about surgery?

Healthwise, 800-706-9646

People who have knee osteoarthritis that is causing pain and stiffness and impacting their activities and quality of life to some degree.

Focuses on the question of whether to have knee replacement surgery or to use nonsurgical treatments (in any combination) to reduce pain and improve function in patients with osteoarthritis of the knee.

Is knee replacement surgery right for me?

Avaz Decisions, 206-717-5955

Adults with osteoarthritis who are eligible for total knee replacement surgery.

Supports adults who have osteoarthritis in deciding whether to a) have total knee replacement surgery or b) decline or delay the procedure, and continue using nonsurgical therapies.

Is hip replacement surgery right for me?

Avaz Decisions, 206-717-5955

Adults with osteoarthritis who are eligible for total hip replacement surgery

Supports adults who have osteoarthritis in deciding whether to a) have total hip replacement surgery or b) decline or delay the procedure, and continue using nonsurgical therapies.

Spinal stenosis: choosing the right treatment for you

Health Dialog Services Corporation

People with symptomatic spinal stenosis (including those with degenerative spondylolisthesis) who are considering either nonsurgical approaches or surgery to manage pain, limited function, and other symptoms

Helps people understand what spinal stenosis is and decide whether they want to use nonsurgical approaches or surgery to manage their pain and other symptoms.

Herniated disk in lower back: treatment options EBSCO Publishing, Inc. 10 Estes St, Ipswich, MA 01938 People with back pain due to a herniated disk for greater than six weeks. It is not for people with back pain from other causes, a herniated disk without symptoms, or symptoms for less than six weeks.

This decision aid is designed to help people with a herniated (slipped) disk understand surgical and nonsurgical treatment options for reducing pain and improving function.

ACP Decisions

The following PDAs are from ACP Decisions. For more information about any of the following tools, please contact executivedirector@acpdecisions.org or acpdecisions.org/contact.

PDA Audience Description

CPR: advanced cancer

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced cancer who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with advanced cancer would like CPR attempted in the hospital.

CPR: advanced disease

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced disease who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with advanced disease would like CPR attempted in the hospital.

CPR: advanced heart failure

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced heart failure who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with advanced heart failure would like CPR attempted in the hospital. More information: contact

CPR: advanced liver disease

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced liver disease who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with advanced liver disease would like CPR attempted in the hospital.

CPR: advanced lung disease

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced lung disease who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with advanced lung disease would like CPR attempted in the hospital.

CPR: a closer look for people with a serious illness

Any competent adult (and their surrogate decision-makers in the event of incapacity) with a serious illness who is making a decision about whether or not they wish to have CPR attempted

Explores whether or not a patient with a serious illness would like CPR attempted in the hospital.

Decisions about dialysis for patients 75 and older

Any competent adult over the age of 75 with frailty (and their surrogate decision-makers in the event of incapacity) who is making a decision about whether or not they wish to have dialysis attempted or pursue supportive kidney care for end-stage renal failure and chronic advanced kidney disease

Explores treatment options for patients with end-stage renal disease or advanced chronic kidney disease.

Goals of care: advanced cancer

Any competent adult (and their surrogate decision-makers) with advanced cancer who is making a decision about what type of medical care they would want if they became ill

Explores what level of medical care a patient with advanced cancer desires in a health care setting.

Goals of care: advanced dementia

Any competent adult (and their surrogate decision-makers) who is considering medical care if they had advanced dementia and is making a decision about what type of medical care they would want if they became ill.

Explores what level of medical care a patient with advanced dementia desires in a health care setting.

Goals of care: advanced disease

Any competent adult (and their surrogate decision-makers) with advanced disease who is making a decision about what type of medical care they would want if they became ill

Explores what level of medical care a patient with advanced disease desires in a health care setting.

Goals of care: advanced heart failure

Any competent adult (and their surrogate decision-makers) with advanced heart failure who is making a decision about what type of medical care they would want if they became ill

Explores what level of medical care a patient with advanced heart failure desires in a health care setting.

Goals of care: advanced lung disease

Any competent adult (and their surrogate decision-makers) with advanced lung disease who is making a decision about what type of medical care they would want if they became ill

Explores what level of medical care a patient with advanced lung disease desires in a health care setting.

Goals of care: family meetings in the ICU

Any surrogate who is making a decision for a patient in the intensive care unit setting about what type of medical care they would want for their loved one

Explores what level of medical care a surrogate (health care proxy, family or friends) desires for their loved one in an intensive care unit setting.

Goals of care: skilled nursing facility

Any competent adult (and their surrogate decision-makers) who is making a decision about what type of medical care they would want if they became ill in the skilled nursing facility setting

Explores what level of medical care a patient desires in a health care setting, specifically the skilled nursing facility.

Hospice: advanced cancer

Any competent adult (and their surrogate decision-makers in the event of incapacity) with advanced cancer who is making a decision about whether or not they wish to have hospice

Explores whether or not a patient with advanced cancer wishes to receive hospice care; reviews what hospice is, the benefits and limits of hospice, and the goal of hospice.

Hospice: skilled nursing facility

Any competent adult (and their surrogate decision-makers in the event of incapacity) who is making a decision about whether or not they wish to have hospice in the skilled nursing setting

Explores whether or not a patient in a skilled nursing facility wishes to receive hospice care; reviews what hospice is, the benefits and limits of hospice, and the goal of hospice.

Hospice: an introduction

Any competent adult (and their surrogate decision-makers in the event of incapacity) who is making a decision about whether or not they wish to have hospice

Explores whether or not a patient wishes to receive hospice care; reviews what hospice is, the benefits and limits of hospice, and the goal of hospice.

Supporting decisions involving extremely premature infants

Any parent who is making decisions about an extremely premature infant

Explores decisions surrounding medical care for infants born extremely premature; reviews the two general approaches that neonatal intensive care units (NICUs) use for medical care for extremely premature infants, namely, life-prolonging care and comfort care.

Dementia for caregivers: goals of care: across the spectrum for Alzheimer's disease Any competent adult (and their surrogate decision-makers in the event of incapacity) who is considering medical care if they had one of the stages of dementia and is making a decision about what type of medical care they would want if they became ill Explores what level of medical care a patient with one of the stages of dementia desires if they become ill and how surrogate decision makers can aid in the decision making process.

Respecting Choices

The following PDAs are from Respecting Choices. For more information, contact Matthew Isbell at misbell@respectingchoices.org, 608-473-3083.

PDA Audience Description

CPR decision aid

People with serious illness (like heart or lung disease or cancer) facing a decision about attempting CPR

Individuals are guided to consider what care they would want if their heart and breathing stops. This decision aid will help an individual consider his/her options for CPR and personal values.

Help with breathing decision aid

People with underlying, serious illness (like heart or lung disease or cancer) facing a decision about getting short-term help with breathing

Individuals are guided to consider what care they would like if they were not able to breathe on their own. This may occur if a person has a problem, like pneumonia, from his/her serious illness. This pneumonia perhaps can be treated, but the person would need help with breathing. This decision aid will help an individual consider his/her options and personal values.

Long-term tube feeding decision aid

People with serious illness (like heart or lung disease, dementia, or cancer) facing a decision about the use of long-term tube feeding

Individuals are guided to consider what care they would want if their illness or disability made it hard to swallow and they were no longer able to eat or drink enough by mouth to maintain nutrition. This decision aid will help an individual consider his/her options and personal values and beliefs.

Others

PDA Organization Audience Description

Medical care for serious illness

Health Dialog Services Corporation

People with a serious illness that is, or may become, life threatening; the family members and loved ones of people who are seriously ill

Gives patients and caregivers information about the importance of participating in treatment decisions during advanced serious illness, stressing the importance of advance care planning to avoid treatments that patients may not want, particularly in situations when they can no longer make medical decisions independently for themselves.

For more information, visit Health Dialog or call 617-406-5200.

Advanced lung cancer patient decision aid

Seattle Cancer Care Alliance

English speaking, advanced stage NSCLC patients considering anticancer treatment and supportive care, supportive care alone, or nontreatment

Helps patients with advanced stage nonsmall cell lung cancer choose between supportive care and anticancer care, supportive care alone and nontreatment. View the decision aid.

For more information, contact Annika Gustafson, MHA, BSN, RN, agustafs@seattlecca.org, 206-606-1049.

PDA Organization Topic Audience Description

Option grid: implantable cardioverter defibrillator for heart failure: yes or no?

EBSCO Publishing, Inc. 10 Estes St, Ipswich, MA 01938

To decide whether or not to get an implantable cardioverter defibrillator (ICD) for patients with heart failure.

Patients with heart failure from blocked arteries or a heart attack and who might benefit from an ICD.

This decision aid is for people with heart failure facing a decision about whether or not to get an ICD. This decision aid compares two options: "yes to ICD" and "no to ICD".

Ischemic heart disease: treatment options for chest pain from one blocked artery

EBSCO Publishing, Inc. 10 Estes St, Ipswich, MA 01938

To decide between treating chest pain from one blocked artery by continuing to only take medicines or by unblocking the artery using a stent.

Patients with chest pain from one blocked artery. It is not for patients who have no pain, pain that happens while at rest, or pain that is getting worse. It is not for patients with more than one blocked artery or high-risk blockages.

This decision aid is for patients with chest pain from one blocked artery to decide between treating chest pain from one blocked artery by continuing to only take medicines or by unblocking the artery using a stent.

Atrial fibrillation: treatment options to lower stroke risk EBSCO Publishing, Inc. 10 Estes St, Ipswich, MA 01938 To help patients with atrial fibrillation decide between treatment options to lower their risk of stroke. Patients with atrial fibrillation, except those with atrial fibrillation due to heart valve problems. This decision aid compares eight different treatment options to help patients with atrial fibrillation lower their risk of stroke. This is not for those patients with atrial fibrillation due to heart valve problems.
Caregiver academy: decisions about breathing and feeding tubes ACP Decisions (nonprofit foundation) 195 Carlton Road, Waban, MA 02468 Cardiopulmonary resuscitation (CPR) and whether or not to attempt in patients with advanced cancer Any caregiver who is making a decision for an intubated patient in the intensive care unit setting regarding tracheostomy and a feeding tube. This decision aid explores decisions surrounding tracheostomies and feeding tubes for patients who are on a ventilator and intubated. These decisions are often made by a caregiver (health care proxy, surrogate, family, or friends) in an intensive care unit setting for a patient who is presently intubated and on a ventilator.
Intubation and breathing machines: a closer look for people 65 and over ACP Decisions (nonprofit foundation), 195 Carlton Road, Waban, MA 02468 Intubation and breathing machines for people 65 and over Any competent adult over the age of 65 (and their surrogate decision-makers in the event of incapacity) who is making a decision about whether or not they wish to have intubation and mechanical ventilation attempted. The decision aid explores the issue of whether or not a patient over 65 would like to be intubated if they are unable to breathe on their own.
         

Is HCA currently accepting certified PDAs?

Not at this time. Please check back in summer 2019 for information about future opportunities. 

What is the cost to submit a PDA for certification?

HCA charges a $3,000 application fee for review of each decision aid. However, we will waive the fee for PDAs that are free to the public.

What happens after HCA certifies a PDA?

  1. HCA notifies the developer of our decision to certify the PDA.
  2. We post information about the PDA and developer. This includes a link to the developer's website, and if available, the certified PDA.

Can I use the PDAs on this page?

Not all PDAs are free or available to the public. In some cases:

  • There may not be a link to the certified PDA.
  • A PDA may only be available through a provider or health care system.
  • Providers may be required to pay a fee to use a PDA with their patients.

Although called "patient" decision aids, PDAs are tools providers can use as part of shared decision making with their patients.

Contact

Email: shareddecisionmaking@hca.wa.gov
Name: Laura Pennington​, practice transformation manager
Phone: 360-725-1231