Patient decision aids (PDAs)

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.

Most PDAs have an associated fee. The cancer screening PDAs are available at no cost.

Learn how to identify a high-quality PDA. 

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.

Learn about the PDA certification process. 

What PDAs has HCA certified?

According to Washington Administrative Code (WAC) 182-60-040, a certification is valid for five years from the date of the written certification determination, except for withdrawal or suspension. The following PDAs marked with an asterisk* are currently undergoing the process for review for recertification. If a PDA does not have an asterisk, its certification is still valid.

Maternity and labor/delivery

The following PDA has an associated fee. For more information, visit the organization's website.

PDA	Organization	Audience	Description
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 certification date: February 19, 2021

Total joint replacement and spine care

The following PDAs have associated fees. For more information, visit the organization's website.

PDA	Organization	Audience	Description
Treatment options for knee osteoarthritis	Emmi Solutions LLC 300 W Adams Suite 1200 Chicago, IL 60606	People with hip osteoarthritis. It is appropriate for patients throughout the disease continuum, from people who are newly diagnosed and/or have mild symptoms to those who have had it long-term and/or have severe symptoms.	This PDA is made available to all Emmi clients (primarily hospitals and health care systems) with a subscription to EmmiEngage or EmmiDecide product lines. Clinicians/health care teams administer the PDA to patients in preparation for a decision around knee OA treatment options. PDA certification date: June 3, 2021
Treatment options for hip osteoarthritis	Emmi Solutions LLC 300 W Adams Suite 1200 Chicago, IL 60606	People with hip osteoarthritis. It is appropriate for patients throughout the disease continuum, from people who are newly diagnosed and/or have mild symptoms to those who have had it long-term and/or have severe symptoms.	This PDA is made available to all Emmi clients (primarily hospitals and health care systems) with a subscription to EmmiEngage or EmmiDecide product lines. Clinicians/health care teams administer the PDA to patients in preparation for a decision around knee OA treatment options. PDA certification date: October 1, 2020

End of life care

ACP Decisions

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

PDA	Audience	Description
Caregiver academy: decisions about breathing and feeding tubes	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. PDA certification date: November 22, 2022
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. PDA certification date: May 19, 2021
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. PDA certification date: May 19, 2021
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.  PDA certification date: May 19, 2021
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. PDA certification date: May 19, 2021
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. PDA certification date: May 19, 2021
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. PDA certification date: May 19, 2021
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. PDA certification date: November 22, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
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. PDA certification date: March 17, 2022
Intubation and breathing machines: a closer look 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. PDA certification date: November 22, 2022
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. PDA certification date: November 22, 2022

Respecting Choices

The following PDAs are from Respecting Choices and have associated fees. For more information, email info@respectingchoices.org or call 608-473-1025.

Learn more by visiting Respecting Choices' website.

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. PDA certification date: November 22, 2022
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. PDA certification date: November 22, 2022
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. PDA certification date: December 23, 2022

Cancer screening

The following PDAs are available at no cost. For more information, email randal.moseley@confluencehealth.org.

PDA	Organization	Audience	Description
Should I Get a Mammogram? (ages 40-49), also translated into Español - Spanish	Confluence Health 1201 S. Miller St. Wenatchee, WA 98801	All women, ages 40-49	This PDA is to help women, ages 40-49, decide if they want to start having mammograms before age 50 and how often to get them, if a woman decides to start having mammograms. PDA certification date: March 1, 2021
How Often Should I Get a Mammogram? (ages 50-74), also translated into Español - Spanish	Confluence Health 1201 S. Miller St. Wenatchee, WA 98801	All women, ages 50-74	This PDA is to help women, ages 50-74, decide how often to get screening mammograms. PDA certification date: March 1, 2021
Should I Get a Mammogram? (ages 75+), also translated into Español - Spanish	Confluence Health 1201 S. Miller St. Wenatchee, WA 98801	All women, ages 75 and older	This PDA is to help women, ages 75 and older, decide if they want to stop or continue getting mammograms. PDA certification date: March 1, 2021

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?

Most PDAs have an associated fee. 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.