The availability and effectiveness of tools supporting shared decision making in metastatic breast cancer care: a review

Inge Spronk,François G Schellevis,Jako S Burgers,Joke C Korevaar,Liesbeth M Van Vliet

doi:10.1186/s12904-018-0330-4

Abstract

BackgroundShared decision-making (SDM) in the management of metastatic breast cancer care is associated with positive patient outcomes. In daily clinical practice, however, SDM is not fully integrated yet. Initiatives to improve the implementation of SDM would be helpful. The aim of this review was to assess the availability and effectiveness of tools supporting SDM in metastatic breast cancer care.MethodsLiterature databases were systematically searched for articles published since 2006 focusing on the development or evaluation of tools to improve information-provision and to support decision-making in metastatic breast cancer care. Internet searches and experts identified additional tools. Data from included tools were extracted and the evaluation of tools was appraised using the GRADE grading system.ResultsThe literature search yielded five instruments. In addition, two tools were identified via internet searches and consultation of experts. Four tools were specifically developed for supporting SDM in metastatic breast cancer, the other three tools focused on metastatic cancer in general. Tools were mainly applicable across the care process, and usable for decisions on supportive care with or without chemotherapy. All tools were designed for patients to be used before a consultation with the physician. Effects on patient outcomes were generally weakly positive although most tools were not studied in well-designed studies.ConclusionsDespite its recognized importance, only two tools were positively evaluated on effectiveness and are available to support patients with metastatic breast cancer in SDM. These tools show promising results in pilot studies and focus on different aspects of care. However, their effectiveness should be confirmed in well-designed studies before implementation in clinical practice. Innovation and development of SDM tools targeting clinicians as well as patients during a clinical encounter is recommended.

Highlights

Shared decision-making (SDM) in the management of metastatic breast cancer care is associated with positive patient outcomes
Shared decision making (SDM) is an approach in which health care providers and patients share the best evidence when facing decisions, and patients are encouraged to be actively involved in decision making [5, 6]
The aims of this study were 1) to make an inventory of instruments and tools, including Decision aid (DA) and tools used during clinical encounters, that are currently available for supporting SDM in metastatic breast cancer care and 2) to evaluate the effectiveness of these tools based on published studies

Summary

Introduction

Shared decision-making (SDM) in the management of metastatic breast cancer care is associated with positive patient outcomes. The aim of this review was to assess the availability and effectiveness of tools supporting SDM in metastatic breast cancer care. SDM has been identified as an important element for good advanced cancer care [7]. Most cancer patients prefer to participate in decision making [8, 9]. Among patients with advanced cancer, women with breast cancer in particular wish to be actively involved in decision making [10]. SDM is associated with positive patient outcomes, including knowledge regarding available options, perceived quality of care [11, 12], and quality of life [13]

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