Shared decision making in pain care: a systematic review study protocol of decision aids

Clinical Snapshot

Key Findings

• P Value: Not applicable — protocol stage

• Effect Size: Not applicable — protocol stage; no pooled effect size available or planned given descriptive aims

• Primary Outcome: No results available — this is a study protocol. The primary aim is to identify and characterise decision aids for pain management across the lifespan, describing their clinical decisions addressed, structures, delivery formats, development processes, and evaluation outcomes.

• Nnt Or Sensitivity: Not applicable — descriptive systematic review protocol; no NNT, sensitivity/specificity, or hazard ratio calculable at this stage

• Confidence Interval: Not applicable — protocol stage

Clinical Application

The completed review will provide a landscape map of existing decision aids, which will directly support clinicians in identifying available tools for implementation. Feasibility of individual decision aids in clinical practice will depend on the formats, delivery modes, and resource requirements described in the completed review. Digital and paper-based formats are likely to be represented. Time constraints in clinical consultations and health literacy variability among pain patients are key implementation considerations. Chronic pain affects approximately 3.4 million Australians (approximately 1 in 7), representing a major public health burden. The RACGP and Faculty of Pain Medicine (ANZCA) have emphasised patient-centred, multimodal approaches to chronic pain management. Decision aids aligned with Australian clinical guidelines — including those addressing opioid prescribing decisions under the PBS, interventional pain procedures, and non-pharmacological options — would be of particular value. The TGA's scheduling of opioid analgesics and the PBS's restrictions on certain pain medications create specific decision contexts where SDM tools could reduce inappropriate prescribing and improve patient outcomes. Indigenous Australian communities face disproportionate chronic pain burden with additional cultural and access considerations that any decision aid implementation strategy must address. The completed review may identify gaps in culturally appropriate decision aids for Australian First Nations peoples. The Australian Commission on Safety and Quality in Health Care's Shared Decision Making program provides a policy framework within which findings from this review could be operationalised. Patients across the lifespan with chronic or acute pain conditions where multiple preference-sensitive treatment options exist. This includes but is not limited to: chronic non-cancer pain, cancer-related pain, post-surgical pain, paediatric pain, and pain in older adults. The review's findings, when complete, will be most directly applicable to clinicians seeking to implement or select decision aids in pain management consultations.

Abstract

INTRODUCTION: Shared decision making (SDM) in healthcare is an ethical imperative and essential to patient-centred care. SDM is particularly useful when several preference-sensitive treatment options exist and in the setting of chronic conditions or longitudinal management. Chronic pain management embodies these characteristics, yet SDM often remains insufficient in this population. Decision aids are designed to facilitate SDM by helping patients and clinicians understand treatment options, clarify patient values, and guide collaborative decision processes. Despite their importance, the use of decision aids in pain management is inconsistent and their reported effectiveness has been variable. However, the current landscape of decision aids for pain management has not been described. This lack of understanding of what tools exist, how they are structured, what decisions they address and how they were developed makes it difficult to advance implementation efforts or identify meaningful gaps in available resources. As such, the purpose of this systematic review is to identify and characterise decision aids for pain management across the lifespan. Specifically, this review will describe the clinical decisions addressed, decision aid structures and delivery formats, development processes and outcomes used to evaluate the impact of existing decision aids. METHODS AND ANALYSIS: Electronic searches were performed in PubMed, CINAHL and Ovid Embase from inception through January 2026. Studies will be assessed for quality using the Mixed Methods Appraisal Tool. Data will be extracted and presented with the aim of describing the: (a) content and structures of pain-related decision aids, (b) development processes used to create existing pain-related decision aids and (c) outcome measures used to evaluate the impact of decision aids in clinical care. ETHICS AND DISSEMINATION: This review does not require ethics approval. Findings will be disseminated to clinicians, researchers and patients through journal publications, conference presentations and in collaboration with patient partners. PROSPERO REGISTRATION NUMBER: CRD420251085288.

References

1. 1.Hess, C. W., McDonnell, A., Sahaym, O., Masood, S., Davis, A., Smyth, H., Nguyen, H., Wong, C., Lipstein, E. A., Zisman-Ilani, Y., & Simons, L. (2026). Shared decision making in pain care: a systematic review study protocol of decision aids. BMJ Open. https://doi.org/10.1136/bmjopen-2026-118847