IPDAS Deliverables, Impact,& Next Steps
2003-2017
IPDAS Steering Committee:
Dawn Stacey/Pending (Co-Leads),
M Barry, N Col, A Coulter, M Härter,V Montori, N Moumjid, M Pignone, R Thomson,
L Trevena, R Volk, T van der Weijden

International Patient Decision AidStandards (IPDAS) Collaboration

Purpose:To enhance the quality and effectivenessof patient decision aids by establishing ashared evidence-informed framework for
improving their content, development,
implementation, and evaluation.

International Patient Decision AidStandards (IPDAS) Collaboration

Steering Committee Functions:
1. Oversee process for maintaining/revising IPDAS criteria
2. Provide guidance to enhance reporting of research on PtDAs
3. Facilitate stakeholder involvement in IPDAS
4. Disseminate and implement IPDAS criteria by overseeing
and setting principles for:- use and refinement of the IPDASi instrument- production of quality-assured IPDAS training materials
5. Monitor progress of IPDAS working groups
6. Approve consensus statements and publication of IPDASInternational Patient Decision AidStandards (IPDAS) Collaboration
IPDAS@listserv.dartmouth.edu
This IPDAS email list is used:1)2)3)
4)

as a membership registerto communicate
to agree on a process to convene a Steering Groupfor future research / development of the IPDAS criteria

To be added, ask a current member to introduce you byciting your interest and expertise relevant to IPDAS. If
you don’t know a member, see Who’s Involved on theIPDAS website at http://ipdas.ohri.ca

IPDAS Phases
2003-2006 IPDAS Checklist
2006-2009 IPDASi Instrument

2009-2013 IPDAS Minimal Standards
2011-2013 Updated evidence underlying theIPDAS Checklist
2014-2017 Reporting guidelines

International Patient Decision AidStandards (IPDAS) Collaboration

Objective:
To establish internationally approved criteria to determine thequality of patient decision aids. These criteria are helpful toindividuals and organizations that use and/or develop patientdecision aids:– Patients– Practitioners– Developers– Researchers– Policy makers or payers>100 participantsfrom 14 countries

To learn more, visit: ipdas.ohri.ca
Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

International Patient Decision Aids Standards
Collaboration Quality Criteria

12 DimensionsEssential Content

Generic Criteria– Development process–Information– Disclosure–

Probabilities– Internet delivery–Values clarification–– BalanceGuidance–

Patient Stories

Effectiveness Criteria–Decision process–Decision quality– Plain language– Up to date evidence

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417.
http://www.ncbi.nlm.nih.gov/pubmed/16908462

Summarized evidence to inform voters

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

Modified Delphi Consensus Voting
for developing the IPDAS Checklist(n=83 criteria from 12 dimensions)
Example of a voting screen for one criterion

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

Results
Only 5/16 criteria with differences between
stakeholders, had medians that straddled
threshold for inclusion
10Evidence: steps used to select included

Probabilities: select way to view
987

6

5

4

3

Probabilities: place chance in context

Update: reports howoften
updated
PolicyPatients

2Internet: search key words

Practitioner

Research10
P2.I.1P2.I.6

P2.III.8

P2.III.9 P2.III.10 P2.VI.1 P2.VI.2 P2.VI.3 P2.VI.4 P2.VI.5 P2.VIII.2 P2.X.1

P2.X.2P2.XI.2 P2.XI.4 P2.XI.5a

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

IPDAS Checklist
74 items in 11 dimensions checked Yes/No(based on equimedian rating of 7 to 9 without disagreement)

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

Elwyn, et al., BMJ. 2006 Aug 26; 333(7565):417. http://www.ncbi.nlm.nih.gov/pubmed/16908462

IPDAS Phases
2003-2006 IPDAS Checklist
2006-2009 IPDASi Instrument

2009-2013 IPDAS Minimal Standards
2011-2013 Updated evidence underlying theIPDAS Checklist
2014-2017 Reporting guidelines

Developing the Instrument
IPDASiTo develop, validate and report the inter-rater
reliability of an instrument designed to measure thequality of patient decision support tools
Stage 1 Refinement and preparation of instrument (version 1)

Stage 2 Confirmation of items (version 2)
Stage 3 Validation Study (version 3)

Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269

IPDASi uses a 4-point scale with items
descriptors (strongly agree to strongly disagree)

Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269

IPDASi Validation Study
Methods:
Two trained and calibrated raters independently appraised:- 15 decision aids from five major producers
•
••
•
•

Healthwise (n=3)
Mayo Clinic (n=3)
Midwives Information and Resource Service (n=3)
Ottawa Patient Decision Aid Research Group (n=3)
Informed Medical Decisions Foundation (n=3)- 15 decision aids randomly selected from Cochrane Inventory

Findings:
After adjusting for hawks/doves IPDASi (47 items)• 33 to 82 (0-100) averaged scores for decision aids
• 0.80 Intraclass correlation (weighted overall score)• 0.72-0.93 Cronbach’s alpha values for the 8 raters
Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269

IPDASi Criteria
IPDASi version# of items
Assessors/Raters# of DSTs evaluatedDimensions
Information
Probabilities
Values
Decision GuidanceDevelopment
Evidence
Disclosure
Plain Language
Evaluation
Test

IPDASi v347IPDASi SF
19

Cardiff: MA-D, MS, NJ, SS;
North America: SK, ED, AS, MP.

Cardiff: MA-D, MS, NJ, SS;
North America: SK, ED, AS, MP.

3030884265212943
132
123

Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269

Elwyn, et al., PLoS One. 2009;4(3):e4705. http://www.ncbi.nlm.nih.gov/pubmed/19259269

IPDAS Phases
2003-2006 IPDAS Checklist
2006-2009 IPDASi Instrument

2009-2013 IPDAS Minimal Standards
2011-2013 Updated evidence underlying theIPDAS Checklist
2014-2017 Reporting guidelines

Process:
1. Delphi consensus 2-round voting on: “If the criterion was not present or of
low quality, there would be a risk of harmful bias and a potential negative
impact on patients’ decision making (127 with some patient decision aidexperience voted from 16 countries)

2. Expert committee considered results from- Vote on risk of harmful bias
- Qualitative comments of voters- Original IPDAS rating- IPDASi trained raters’ comments on feasibility
Joseph-Williams, et al., MDM. 2014; https://www.ncbi.nlm.nih.gov/pubmed/23963501

IPDAS v4.0
Items across the 3 Categories
Dimensions
Information
Probabilities
Values
Guidance
Development
Evidence
Disclosure
Plain Language
Evaluation
Test

Totals# of Criteria / Category
Qualifying

Certification

Quality

51261262
11252814164
10Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501

Summary of qualifying criteria
1. describes the health condition or problem
2. explicitly states the decision that needs to be considered

3. describes the options available
4. describes the positive features
5. describes the negative features
6. describes what it is like to experience the consequences

Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501

Summary of certifying criteria
1. equal detail for negative and positive features of options
2. citations to the evidence
3. production or publication date
4. update policy
5. information about uncertainty around probabilities
6. funding source used for development
For screening decision aids7. describes what the test is designed to measure
8. next steps after positive test result
9. next steps after negative test result
10. consequences of detecting a benign condition
Joseph-Williams, et al., MDM. 2013 Aug 20. https://www.ncbi.nlm.nih.gov/pubmed/23963501

IPDAS Phases
2003-2006 IPDAS Checklist
2006-2009 IPDASi Instrument

2009-2013 IPDAS Minimal Standards
2011-2013 Updated evidence underlying theIPDAS Checklist
2014-2017 Reporting guidelines

2012 Update of the IPDAS Collaboration
Background Document

2013 Peer-reviewed Publications for IPDASCollaboration’s Quality Dimensions

BMC Medical Informatics and Decision Making 2013, 13(Suppl 2).
http://www.biomedcentral.com/bmcmedinformdecismak/supplements/13/S2

Summary of 2013 findings
More emphasis on:
1. Quality of the evidence• For example, use GRADE

2. Disclosures of actual/potential conflict ofinterest• For example, report that no funding to develop
or exclusively distribute has been received fromcommercial for profit entities that sell options inthe PtDA

IPDAS Phases
2003-2006 IPDAS Checklist
2006-2009 IPDASi Instrument

2009-2013 IPDAS Minimal Standards
2011-2013 Updated evidence underlying theIPDAS Checklist
2014-2017 Reporting guidelines

IPDAS Uptake & Impact• Citations– 994 IPDAS Checklist (Elwyn et al 2006)– 241 IPDASi (Elwyn et al 2009)– 76 IPDAS Minimal Standards (Joseph-Williams et al 2014)– 78 Ten Years of IPDAS Collaboration (Volk et al 2013)(Google Scholar August 10, 2017)

A to Z Decision Aid
Inventory uses IPDAS
http://decisionaid.ohri.ca

Note: The OHRI Patient
Decision Aids site is not partof IPDAS. It uses the IPDAS
criteria to rate aids listed inthe Inventory.

Proposed certification criteria are based on IPDASNorway is using IPDAS• In December 2016, the Norwegian Health Directorateused the IPDAS standards to establish a set of quality
criteria for approving patients decision aids prior tobeing added to the Norwegian health platform.
• All Norwegians and health care professionals haveaccess to resources on this health platform.

https://helsedirektoratet.no/nasjonale-kvalitetskrav-tilsamvalgsverktoy-som-skal-publiseres-pa-helsenorgeno

ipdas.ohri.ca has >16,000 visitors per year
generating 60,000 page views and 42,000 downloads
Website requests:- Translate IPDAS- Advice on:- developing PtDAs- reviewing PtDAs- Certifying PtDAs- Pediatric-specificcriteria

For discussion• What suggestions do you have for new
IPDAS initiatives?
• How might you want to be involved?