Abstract
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.
Highlights
Main Findings To examine the association of prostate cancer screening decision aids with decisional outcomes and screening decisions, we pooled data from 19 trials
Low-quality evidence suggests that decision aids are associated with an improvement in men’s knowledge regarding prostate cancer screening, and moderate-quality evidence suggests that decision aids are associated with a small decrease in decisional conflict
Ivlev and colleagues[49] have published the most recent systematic review on prostate cancer screening patient decision aids and concluded that integration of decision aids in clinical practice may result in a decrease in the number of men who elect to undergo PSA testing, which may in turn reduce screening uptake
Summary
Of 19 eligible trials (12 781 men), 9 adequately concealed allocation and 8 blinded outcome assessment.
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