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International Journal of Clinical and Experimental Medicine Research

ISSN Online: 2575-7970 Downloads: 324400 Total View: 3033532
Frequency: bimonthly ISSN Print: 2575-7989 CODEN: IJCEMH
Email: ijcemr@hillpublisher.com
Article Open Access http://dx.doi.org/10.26855/ijcemr.2025.05.025

Effectiveness of Patient Decision Aids in Mitigating Infertility Treatment Decision Conflict: A Policy-aware Meta-analysis

Xiaoyan Wu1, Feixia Sun2, Na Wang1,*

1Hospital for Reproductive Medicine Affiliated to Shandong University, Jinan 250021, Shandong, China.

2Occupational Diseases Hospital of Shandong First Medical University, Jinan 250100, Shandong, China.

*Corresponding author: Na Wang

Published: June 11,2025

Abstract

Objectives: To evaluate how fertility support policies moderate the efficacy of patient decision aids (PDAs) in mitigating decision conflict among individuals with infertility, and to characterize the synergistic mechanisms between policy environments and PDA design. Methods: Using the Ottawa Decision Support Framework (ODSF), we conducted an integrated umbrella review and meta-analysis of 18 studies (n = 4,215). Policies were stratified into three support levels (high/medium/low) based on quantifiable indicators such as the reimbursement rate for assisted reproductive technology (ART) and service accessibility. The standardized mean difference (SMD) was pooled via a random-effect model to test the dose-response relationship between policy intensity and PDA effectiveness. Results: PDA significantly mitigated decision conflict (SMD = -0.61, 95% CI [-0.80, -0.42]), with policy support levels accounting for 34.7% of the between-study heterogeneity (β = -0.12, p = 0.03). The effect size in high policy support areas (SMD = -0.82) was significantly greater than in low policy support areas (SMD = -0.35, p = 0.008). While digital PDAs showed higher acceptability in low- and middle-income countries (OR = 2.3), they were associated with a 2.1-fold increased dropout rate, necessitating localized adaptations (such as offline functionality) to bridge the digital divide. Conclusion: Policy support enhances PDA effectiveness through dual pathways of financial relief and institutional trust. A 'policy tier-tool adaptation' model should be constructed, with high support areas focusing on value clarification and low support areas prioritizing cost simulation and community resource integration.

References

[1] World Health Organization. Selected practice recommendations for contraceptive use. Geneva: WHO; 2016. Available from:

https://apps.who.int/iris/bitstream/handle/10665/252267/9789241565400-eng.pdf

[2] Bitzer J, Abalos V, Apter D, et al. Targeting factors for change: contraceptive counseling and care of female adolescents. Eur J Contracept Reprod Health Care. 2016;21(6):417-30.

[3] World Health Organization. Adolescent pregnancy. Geneva: WHO; 2023. Available from:
https://www.who.int/en/news-room/fact-sheets/detail/adolescent-pregnancy

[4] United Nations. Resolution XVIII. Human Rights Aspects of Family Planning, Final Act of the International Conference on Human Rights. New York: UN; 1968. Doc. A/CONF. 32/41, p.15.

[5] United Nations Department of Economic and Social Affairs. World Family Planning 2022: meeting the changing needs for family planning. New York: UN; 2022. Report No.: UN DESA/POP/2022/TR/NO. 4. Available from: 

https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/documents/2023/Feb/undesa_pd_2022_world-family-planning.pdf

[6] Marshall C, Kandahari N, Raine-Bennett T. Exploring young women's decisional needs for contraceptive method choice: a qualitative study. Contraception. 2018;97(3):243-8.

[7] Todd N, Black A. Contraception for adolescents. J Clin Res Pediatr Endocrinol. 2020;12(Suppl 1):28-40.

[8] Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. JAMA. 2021;326(24):2507-18.

[9] Nucci-Sack A, Rojas M, Alpert IL, et al. Approach to and evaluation of the adolescent female. In: Altchek ADL, editor. Pediatric, adolescent & young adult gynecology. Chichester: Wiley-Blackwell; 2009. p.134-40.

[10] World Health Organization. Adolescent Sexual Reproductive Health. Geneva: WHO; 2023. Available from: https://www.who.int/southeastasia/activities/adolescent-sexual-reproductive-health

[11] Durante JC, Sims J, Jarin J, et al. Long-acting reversible contraception for adolescents: a review of practices to support better communication, counseling, and adherence. Adolesc Health Med Ther. 2023;14:97-114.

[12] Stacey D, Hill S, McCaffery K, et al. Shared decision-making interventions: theoretical and empirical evidence with implications for health literacy. Stud Health Technol Inform. 2017;240:263-83.

[13] Stacey D, Légaré F, Boland L, et al. 20th anniversary Ottawa decision support framework: part 3 overview of systematic reviews and updated framework. Med Decis Making. 2020;40(3):379-98.

[14] D'Souza P, Bailey JV, Stephenson J, Oliver S. Factors influencing contraception choice and use globally: a synthesis of systematic reviews. Eur J Contracept Reprod Health Care. 2022;27(5):364-72.

[15] D'Souza P, Phagdol T, D'Souza SRB, et al. Interventions to support contraceptive choice and use: a global systematic map of systematic reviews. Eur J Contracept Reprod Health Care. 2023;28(2):83-91.

[16] Aromataris E, Fernandez R, Godfrey CHC, et al. Chapter 10: Umbrella Reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. Adelaide: JBI; 2020. Available from:
https://synthesismanual.jbi.global

[17] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

[18] O'Connor AM, Tugwell P, Wells GA, et al. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33(3):267-79.

[19] Hoefel L, O'Connor AM, Lewis KB, et al. 20th anniversary update of the Ottawa decision support framework Part 1: a systematic review of the decisional needs of people making health or social decisions. Med Decis Making. 2020;40(5):555-81.

[20] Methley AM, Campbell S, Chew-Graham C, et al. PICO, PICOS, and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014;14:579.

[21] The World Bank. The World by Income and Region. Washington: World Bank; 2022. Available from: https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html

[22] Sedgh G, Finer LB, Bankole A, et al. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health. 2015;56(2):223-30.

[23] Munakampe MN, Zulu JM, Michelo C. Contraception and abortion knowledge, attitudes, and practices among adolescents from low and middle-income countries: a systematic review. BMC Health Serv Res. 2018;18(1):909.

[24] Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91-108.

[25] McGowan J, Sampson M, Salzwedel DM, et al. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-6.

[26] Gemzell-Danielsson K, Kubba A, Caetano C, et al. Thirty years of Mirena: a story of innovation and change in women's healthcare. Acta Obstet Gynecol Scand. 2021;100(4):614-8.

[27] Mack N, Crawford TJ, Guise JM, et al. Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception. Cochrane Database Syst Rev. 2019;4(4):CD004317.

[28] CADTH. SR/MA/HTA/ITC - CINAHL. In: CADTH Search Filters Database. Ottawa: CADTH; 2023. Available from: https://searchfilters.cadth.ca/link/98

[29] CADTH. SR/MA/HTA/ITC - MEDLINE, Embase, PsycInfo. In: CADTH Search Filters Database. Ottawa: CADTH; 2023. Available from: https://searchfilters.cadth.ca/link/33

[30] Joseph-Williams N, Newcombe R, Politi M, et al. Toward minimum standards for certifying patient decision aids: a modified Delphi consensus process. Med Decis Making. 2014;34(6):699-710.

[31] Martin RW, Brogård Andersen S, O'Brien MA, et al. Providing balanced information about options in patient decision aids: an update from the International Patient Decision Aid Standards. Med Decis Making. 2021;41(7):780-800.

[32] Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

[33] Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal Tools for use in JBI Systematic Reviews. Adelaide: JBI; 2017. Available from:
https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Systematic_Reviews2017_0.pdf

[34] Baxter S, Blank L, Guillaume L, et al. Views of contraceptive service delivery to young people in the UK: a systematic review and thematic synthesis. J Fam Plann Reprod Health Care. 2011;37(2):71-84.

[35] Fox E, Reyna A, Malcolm NM, et al. Client preferences for contraceptive counseling: a systematic review. Am J Prev Med. 2018;55(5):691-702.

[36] Reis YN, Vilela AL, de Souza Costa A, et al. Factors associated with adolescents' choice to use long-acting reversible contraceptives: a systematic review. Curr Obstet Gynecol Rep. 2018;7(4):153-62.

[37] Ti A, Soin K, Rahman T, et al. Contraceptive values and preferences of adolescents and young adults: a systematic review. Contraception. 2022;111:22-31.

[38] Daley AM. What influences adolescents' contraceptive decision-making? A meta-ethnography. J Pediatr Nurs. 2014;29(6):614-32.

[39] Kirubarajan A, Li X, Yau M, et al. Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis. Fertil Steril. 2022;118(1):168-79.

[40] Jones A, Allison BA, Perry M. Effectiveness of contraceptive decision aids in adolescents and young adults: a systematic review. J Pediatr Adolesc Gynecol. 2022;35(1):7-17.


How to cite this paper

Effectiveness of Patient Decision Aids in Mitigating Infertility Treatment Decision Conflict: A Policy-aware Meta-analysis

How to cite this paper: Xiaoyan Wu, Feixia Sun, Na Wang. (2025) Effectiveness of Patient Decision Aids in Mitigating Infertility Treatment Decision Conflict: A Policy-aware Meta-analysis. International Journal of Clinical and Experimental Medicine Research9(3), 386-396.

DOI: http://dx.doi.org/10.26855/ijcemr.2025.05.025