Commentary on History of IPDAS

This issue contains an outstanding collection of articles summarizing the third evidence update for the International Patient Decision Aid Standards (IPDAS). The IPDAS Collaboration has worked conscientiously for almost 2 decades, having been formed out of a desire to ‘‘enhance the quality and effectiveness of patient decision aids by establishing a shared evidence-informed framework with a set of criteria for improving their content, development, implementation and evaluation. ’’ Patient decision aids are ‘‘evidence-based tools designed to help patients make specific and deliberated choices among healthcare options. [They] supplement (rather than replace) clinician’s counselling about options. ’’ While the term shared decision making was coined almost 40 years ago during attempts to reform health communication and improve informed consent, it was possibly the development of the Ottawa Decision Support Framework, the Decisional Conflict Scale, and early decision aid trials that inspired the scientific rigor so well exemplified by this latest IPDAS evidence update. By the time the IPDAS collaboration was established in 2003, the Cochrane review authors reported that the number of identified decision aids had grown from 87 to over 200 in just 2 years, but only 30 of these had been evaluated by published randomized controlled trials (RCTs), and there was no easy way for users of patient decision aids (PDAs) to be able to assess the quality of these tools. Thus, the newly established IPDAS Collaboration used a 2-stage Delphi process to establish 12 quality dimensions, and an exhaustive checklist of 74 criteria was developed from the first evidence review and published background documents. An analysis of trials in the Cochrane review soon after this showed a positive association between decision quality and PDAs that included these quality dimensions. Recognizing the unwieldiness of the checklist, it was refined over the following years, resulting in a 44-item instrument (IPDASi v4.0) to quantitatively rate the quality of PDAs with items designated as ‘‘qualifying,’’ ‘‘certification,’’ or ‘‘quality’’ criteria. By 2013, the second evidence updates were published, and the IPDAS criteria remained unchanged. However, in applying IPDASi v4.0 to PDAs evaluated between 2012 and 2015, the Cochrane review authors found that reporting was incomplete and suboptimal, making it very difficult to assess the quality of published tools despite the existence of IPDAS. Members of the collaboration subsequently developed reporting guidelines for patient decision aid evaluation studies though the EQUATOR network to address this issue. It is incredible that this substantive body of work has been achieved by a group of dedicated people with no formal infrastructure or funding. It is timely, therefore, that this third evidence update coincides with the IPDAS Collaboration being formally incorporated within the Society for Medical Decision Making and finding a longer-term home as shared decision making becomes mainstream policy in many nations around the world. So how can the IPDAS vision continue to improve PDA quality and effectiveness, and what are some of the challenges facing this work in the future? First, it is clear from this series of articles that the science of decision making continues to advance. The 44-item IPDASi checklist has been shown to align with higher-quality