Appraising the quality of patient decision aids for brain and heart health: An environmental scan with a health equity lens

Figure 1. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) diagram. AMC, Academic Medical Center; DAs, decision aids; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; PtDAs, patient DAs. Google, Google Scholar (Google, Mountain View, CA)

Figure 2. Location of brain–heart considerations within international patient decision aid standards (IPDAS) qualifying criteria, the patient decision aid (PtDA) title, and knowledge test (if applicable). The proportion of brain–heart considerations that were explicitly incorporated within each IPDAS criterion for PtDAs focused on (A) combined cardiac and brain as primary condition (n = 9), (B) cardiovascular disease as a primary condition(n = 36), or (C) brain/mental health as a primary condition (n = 6). All PtDAs met all IPDAS qualifying criteria. The figure does not represent whether IPDAS qualifying criteria were met, but where brain–heart connections were explicitly mentioned within each criterion. The 7 IPDAS qualifying criteria are as follows: (1) describes the health condition; (2) explicitly states the decision to be considered; (3) identifies the target audience; (4) lists options, including if relevant, “wait and see” (eg, making no change, doing nothing); (5) describes positive features of options (benefits); (6) describes negative features of options (harms); (7) asks patients to think about which positive and negative features of options matter most to them OR describes what…

Figure 3. Patient education materials assessment tool—printable materials (PEMAT-P) item-level agreement across printable patient decision aids (PtDAs; n = 45). Bars represent the proportion of PtDAs rated as “Agree” for each PEMAT-P item, with values calculated after excluding items marked not applicable (N/A), in accordance with PEMAT scoring guidance. Understandability items (items 1–17) assess clarity, organization, and presentation of information. Actionability items (items 18–24) assess whether the material clearly identifies actions users can take and provides sufficient guidance to support those actions. Higher percentages indicate that a greater proportion of PtDAs met the specified criterion. Blue bars represent the percentage of PtDAs that met the PEMAT criterion, defined as items rated “Agree” by reviewers. Grey bars represent the percentage of PtDAs for which the PEMAT item was not applicable (N/A) and was therefore excluded from the scoring.