91 Including information on overdiagnosis in shared decision making – a review of prostate cancer screening decision aids

Abstract

<h3>Background</h3> Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including: overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. <h3>Methods</h3> We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. <h3>Results</h3> Forty one decision aids were included. Most decision aids (n=32, 79%) did not use the term ‘overdiagnosis’ but included a description of it (n=38, 92%). Few (n=7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms (n=22, 54%), and two out of five (n=16, 39%) presented information on competing risks of mortality. Only two (n=2, 5%) reported the prevalence pool of incidental prostate cancer. <h3>Conclusion</h3> Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display.