US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening.
To estimate the association of decision aids with decisional outcomes in prostate cancer screening.
MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018.
Randomized trials comparing decision aids for prostate cancer screening with usual care.
Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence.
Knowledge, decisional conflict, screening discussion, and screening choice.
Of 19 eligible trials (12 781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality).
The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.
JAMA internal medicine. 2019 Jun 24 [Epub ahead of print]
Jarno M Riikonen, Gordon H Guyatt, Tuomas P Kilpeläinen, Samantha Craigie, Arnav Agarwal, Thomas Agoritsas, Rachel Couban, Philipp Dahm, Petrus Järvinen, Victor Montori, Nicholas Power, Patrick O Richard, Jarno Rutanen, Henrikki Santti, Thomas Tailly, Philippe D Violette, Qi Zhou, Kari A O Tikkinen
Department of Urology, Tampere University Hospital, Tampere, Finland., Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada., Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Department of Medicine, University of Toronto, Toronto, Ontario, Canada., Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada., Urology Section, Minneapolis Veterans Administration Health Care System, Minneapolis, Minnesota., Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota., Division of Urology, Department of Surgery, Western University, London, Ontario, Canada., Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada., Department of Internal Medicine, Tampere University Hospital, Tampere, Finland., Department of Urology, Ghent University Hospital, Gent, Belgium.