Annette M. O’Connor is a distinguished figure in the field of healthcare, renowned for her groundbreaking work in patient decision aids and shared decision-making. Her research and the tools she developed have significantly transformed how patients engage with complex health choices. This article delves into her key contributions, highlighting the profound impact of her decision-making tools, particularly the widely recognized Decisional Conflict Scale and the comprehensive Ottawa Decision Support Framework.
Widely Used Evaluation Measure: The Decisional Conflict Scale
One of O’Connor’s most impactful contributions is the Decisional Conflict Scale (DCS). This evaluation measure, validated in her seminal 1995 publication in Medical Decision Making, has become an indispensable tool for researchers and clinicians alike. The DCS effectively quantifies the uncertainty and internal conflict individuals experience when facing health-related decisions.
Its widespread adoption and enduring relevance are evidenced by the “Anniversary Review” published in Medical Decision Making in 2019. This review, spanning two decades of DCS use, underscores its consistent value in diverse healthcare contexts. A subsequent publication in the same anniversary review further explored DCS findings across various patient and surrogate decision-making scenarios, solidifying its position as a robust and versatile measure in the field.
Conceptual Framework: Decision Support as a Clinical Skill
O’Connor’s influence extends beyond evaluation tools to the very conceptualization of decision support in clinical practice. She co-authored a pivotal paper in Patient Education and Counselling (1998) outlining a decision support framework for women considering hormone therapy after menopause. This framework not only provided a structured approach but also championed decision support as a crucial clinical skill.
The Ottawa Decision Support Framework (ODSF), further developed and refined through subsequent research, stands as a testament to this conceptual framework. A 2006 Medical Decision Making article demonstrated the ODSF’s impact on aligning patient-physician agreement and reducing decisional conflict. The framework’s 20th-anniversary update in Medical Decision Making (2020) reflects its continued evolution and enduring importance in guiding shared decision-making practices.
Randomized Trials of Patient Decision Aids
O’Connor’s work is deeply rooted in empirical evidence, with numerous randomized controlled trials evaluating the effectiveness of patient decision aids (PDAs). Her 1998 Medical Decision Making study showcased a portable, self-administered PDA for post-menopausal hormone therapy decisions.
Further randomized trials explored PDAs in diverse clinical areas, including antithrombotic therapy for stroke prevention in atrial fibrillation (JAMA, 1999), lung transplantation for cystic fibrosis patients (American Journal of Respiratory and Critical Care Medicine, 2009), and as highlighted in the 20th-anniversary update of the ODSF (Medical Decision Making, 2020). These trials collectively provide strong evidence for the efficacy of PDAs in enhancing patient engagement and decision quality.
Methodological Issues in Developing/Evaluating Patient Decision Aids
Recognizing the complexities of PDA research, O’Connor also addressed methodological challenges in their development and evaluation. A 1999 publication in the Journal of the National Cancer Institute Monographs examined evidence of PDA efficacy and policy implications within the context of cancer outcomes, contributing to the rigorous methodological standards in the field.
First Large-Scale Surveys of Physicians’ Attitudes Toward Decision Support
O’Connor’s research extended to understanding the perspectives of healthcare providers regarding decision support. Her 1997 Patient Education and Counseling study surveyed physicians’ opinions on decision aids for adjuvant therapy in breast cancer. Another study in the Canadian Medical Association Journal (1997) explored respirologists’ views on decision-making and mechanical ventilation in end-stage COPD. These surveys provided crucial insights into physician attitudes, paving the way for better implementation strategies for decision support tools.
First Systematic Review of Trials of Patient Decision Aids
O’Connor spearheaded the first Cochrane systematic review of patient decision aids, published in the British Medical Journal in 1999. This landmark review synthesized evidence from trials evaluating PDAs for various health treatment and screening decisions, establishing a robust evidence base for their effectiveness and informing clinical practice guidelines.
First National Survey of a Population’s Health Decisional Needs
To understand the broader population’s needs related to health decisions, O’Connor led a national survey of Canadians, published in Health Expectations in 2003. This survey provided valuable data on the decision-making needs of the public, highlighting areas where decision support interventions could be most beneficial and informing policy initiatives.
First Trials to Improve Decision Support Skills of Health Coaches
Expanding the reach of decision support, O’Connor conducted pioneering trials to enhance the decision support skills of health coaches. A 2006 Journal of Telemedicine and Telecare study evaluated an intervention to implement evidence-based patient decision support in a nursing call center. Further research in the Journal of Palliative Care (2010) focused on skills training for supporting patients considering end-of-life care options. These trials demonstrated the feasibility and impact of training healthcare professionals beyond physicians in delivering effective decision support.
First International Standards for Patient Decision Aids
Recognizing the need for quality standards in the burgeoning field of PDAs, O’Connor played a leading role in the International Patient Decision Aids Standards (IPDAS) Collaboration. The 2006 British Medical Journal publication outlined the development of a quality criteria framework for PDAs through an international Delphi consensus process, establishing essential benchmarks for PDA development and evaluation globally.
Policy Paper on Implementing Patient Decision Aids
O’Connor’s influence extends to policy, with a significant Health Affairs paper in 2007 addressing the critical issue of accelerating the diffusion of decision aids. This policy paper advocated for strategies to overcome barriers to PDA implementation, emphasizing their potential to empower patients and improve healthcare value.
First Canadian Case Study of Implementing Shared Decision Making in a Health Service
O’Connor’s work also includes practical implementation research. A 2006 BMC Implementation Science case study examined the adoption and sustainability of decision support within a nursing context in Canada. This real-world example provides valuable lessons for healthcare systems seeking to integrate shared decision-making and patient decision aids into routine practice.
Conclusion
Dr. Annette M. O’Connor’s extensive body of work has fundamentally shaped the landscape of patient decision-making. From the widely used Decisional Conflict Scale to the comprehensive Ottawa Decision Support Framework and her leadership in establishing international standards for patient decision aids, her contributions are both profound and far-reaching. Her pioneering research continues to empower patients, enhance shared decision-making, and improve the quality and patient-centeredness of healthcare globally. O’Connor’s tools and frameworks are not just academic contributions; they are practical resources that enable individuals to navigate complex health choices with greater clarity and confidence, making her work invaluable to patients and healthcare professionals alike.
