JMIR Publications

ABSTRACT

A digitally enabled health system offers the opportunity to address gaps in implementation of shared decision making, a collaborative process between health professionals and consumers to decide on the best test, treatment or management option, based on clinical evidence, and the consumer’s values and informed preferences. There is increasing availability of tools available online and integrated in patient platforms and clinical software to support shared decision making. Providing opportunities for all consumers to make shared health care decisions is not only key to achieving safer, higher quality healthcare, but also an ethical and social imperative that upholds the fundamental rights of every health consumer. However, there is a risk that digital tools intended to support shared decision making might worsen inequities in access to health information. In this Viewpoint, we use the case study of digital decision aids to argue that equity should be proactively prioritised as these tools are increasingly designed, accessed and adopted. We highlight the need for digital health researchers and organisations to 1) address health literacy and accessibility by design, 2) meaningfully co-design tools with underrepresented end-users, and 3) generate evidence among underrepresented end-users on how emerging innovations with potential for meeting more diverse needs impact decision making outcomes (e.g., interactivity, tailoring and artificial intelligence). We summarise the current gaps in addressing these recommendations in development and implementation of digital decision aids. We also urge policymakers advocating for consumer engagement in health decisions to invest in 1) national, standardised online portals that streamline and enhance consumer and clinician access to health literate, accessible, co-designed digital decision aids and 2) digital inclusion initiatives that ensure equitable access and adoption of digital tools to support shared decision making.