Patient decision aids (PDAs) are evidence-based tools that facilitate shared decision-making (SDM) between patients and healthcare professionals. These tools are used when multiple treatment options exist, no clear choice prevails regarding risks versus benefits, and the best option may vary depending on patient values. A 2024 Cochrane review of 209 randomized controlled trials involving over 107,000 participants identified the substantial benefits of PDAs,1 including improved patient knowledge, increased SDM and enhanced accuracy of risk perceptions and alignment of decisions with patient values. Given these benefits, SDM tools are more widely used. However, their quality remains inconsistent, potentially limiting their benefit.2-4 Dermatology is particularly suited to SDM, given the wide-ranging and ever-evolving treatment options for conditions that often convey a significant psychological burden. A literature review was conducted to assess dermatologic PDAs for adherence with reporting the development process according to the International Patient Decision Aids Standards (IPDAS) Collaboration.5-8 A comprehensive search using MEDLINE (via PubMed) and EMBASE identified articles on dermatological PDA development from 2014 to 2024. After screening 509 publications, 11 studies describing 14 PDAs across eight conditions, psoriasis (2), acne (1), superficial, low and high-risk basal cell carcinoma (4), vitiligo (1), actinic keratoses (3), metastatic malignant melanoma (1), lentigo maligna (1) and hidradenitis suppurativa (1), were included. Data extraction followed Coulter et al.'s9 template for documenting PDA development, focusing on adherence to IPDAS reporting standards. Most studies (10/11) were published in the last 5 years (2020–2024). All PDAs aimed to support patients with a treatment decision (Table 1). Clinical guidelines (5/14) and literature reviews (4/14) were the most common information sources. Five studies did not report this step. Digital PDAs were most common (6/14), although 4 studies only provided images of the PDA, without stating the format. While most PDAs (10/14) reported adhering to the IPDAS framework with an iterative process, only three included all the required development steps (Figure 1). Clinician needs assessments were infrequently conducted (4/14), with just three specifying numbers involved. In contrast, patient needs assessments were more consistently reported (9/14), although only six provided details on patient numbers. Alpha testing with patients was reported in nearly all studies (12/14), reflecting strong patient engagement, but 4 of these did not provide participant numbers, limiting insight into testing scope. Across the PDAs, patient involvement was nearly double that of clinicians, with a median of 20 (IQR = 33) versus 13 (IQR = 38). Patient participation ranged widely from 7 to 322 individuals, while clinician numbers ranged from 8 to 51. Notably, no patient or clinician numbers were reported for any step in the development of PDAs that did not use the IPDAS development framework. This review of dermatologic PDAs reveals that many lack key elements of the IPDAS development process, such as expert panel involvement, needs assessments and usability testing. While most PDAs were reported to align with the IPDAS framework, a substantial number lacked transparency in their development process which may explain the previously reported variations in dermatologic PDA quality.4 For PDAs to effectively support patient-centred SDM, they must undergo a thorough development process with broad user engagement as demonstrated by our research group's development of a PDA for multiple AKs.10 We suggest developers follow the streamlined IPDAS development framework outlined by Witteman et al.7 and Coulter et al.9 which emphasizes iterative development, evidence-based content and stakeholder engagement through minimal, medium and maximal approaches. These approaches ensure both patients and clinicians are included in all development phases and define a minimum required number for user involvement. Future research should prioritize adherence to these standardized development frameworks. The study was completed in partial fulfillment of a doctorate of medicine funded by a research grant from The City of Dublin Skin and Cancer Hospital Charity. The funders were not involved in the study design, data collection, data analysis or manuscript preparation. The authors declare no conflicts of interest. Not applicable. Not applicable. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Drumm et al. (Sun,) studied this question.