Research endeavors to determine the effectiveness of patient decision aids (PtDAs) have yielded mixed results. The conflicting evaluations are largely due to the different metrics used to assess the validity of judgments made using PtDAs. The different approaches can be characterized by Hammond’s (1996) two frameworks for evaluating judgments: correspondence and coherence. This paper reviews the literature on the effectiveness of PtDAs and recasts this argument as a renewed debate between these two meta-theories of judgment. Evaluation by correspondence criteria involves measuring the impact of patient decision aids on metrics for which there are objective, external, and empirically justifiable values. Evaluation on coherence criteria involves assessing the degree to which decisions follow the logical implications of internal, possibly subjective, value systems/preferences. Coherence can exist absent of correspondence and vice versa. Therefore, many of the seemingly conflicting results regarding the effectiveness of PtDAs can be reconciled by considering that the two meta-theories contribute unique perspectives. We argue that one approach cannot substitute for the other, and researchers should not deny the value of either approach. Furthermore, we suggest that future research evaluating PtDAs include both correspondence and coherence criteria.

Objectives: The aim of this study was to develop a breast cancer Patient Decision Aid (PDA), using a Health Technology Assessment (HTA) process, to assist patients in their choice of therapeutic options, and to promote shared decision making among patients, healthcare professionals, and other interested parties.

Methods: A systematic review (SR) was conducted of existing breast cancer patient Decision Aids encountered in the main scientific journal databases and on institutional Web sites that create PDAs, together with a Qualitative Research (QR) study, using semi-structured interviews and focus group with stakeholders (patients, family members, and health professionals), with the aim of developing a PDA for breast cancer.

Results: The SR shows that PDAs in breast cancer not only increase patient knowledge of the illness, leading to more realistic expectations of treatment outcomes, but also reduce passivity in the decision-making process and facilitate the appropriate choice of treatment options in accordance with patient medical and personal preferences. The analysis of QR shows that both breast cancer patients and healthcare professionals agree that surgery, adjuvant treatments, and breast reconstruction represent the most important decisions to be made. Worry, anxiety, optimism, and trust in healthcare professionals were determined as factors that most affected patients subjective experiences of the illness. This HTA was used as the basis for developing a PDA software program.

Conclusions: The SR and QR used in the development of this PDA for breast cancer allowed patients to access information, gain additional knowledge of their illness, make shared treatment decisions, and gave healthcare professionals a deeper insight into patient experiences of the disease.