Medical decisions concerning active surveillance are complex, especially when evidence on superiority of one of the treatments is lacking. Decision aids have been developed to facilitate shared decision-making on whether to pursue an active surveillance strategy. However, it is unclear how these decision aids are designed and which outcomes are considered relevant. The purpose of this study is to systematically review all decision aids in the field of oncological active surveillance strategies and outcomes used by authors to assess their efficacy.
A search was performed in Embase, Medline, Web of Science, Cochrane, PsycINFO Ovid and Google Scholar until June 2019. Eligible studies concerned interventions aiming to facilitate shared decision-making for patients confronted with several treatment alternatives, with active surveillance being one of the treatment alternatives. Twenty-three eligible articles were included. Twenty-one articles included patients with prostate cancer, one with thyroid cancer and one with ovarian cancer. Interventions mostly consisted of an interactive web-based decision aid format. After categorization of outcomes, seven main groups were identified: knowledge, involvement in decision-making, decisional conflict, treatment preference, decision regret, anxiety and health-related outcomes. Although active surveillance has been implemented for several malignancies, interventions that facilitate shared decision-making between active surveillance and other equally effective treatment alternatives are scarce. Future research should focus on developing interventions for malignancies like rectal cancer and oesophageal cancer as well. The efficacy of interventions is mostly assessed using short-term outcomes.
Current oncology reports. 2020 Jul 28*** epublish ***
G E Collée, B J van der Wilk, J J B van Lanschot, J J Busschbach, L Timmermans, S M Lagarde, L W Kranenburg
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands., Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands. ., Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands., Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands.