Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis

Philippe D Violette; Thomas Agoritsas; Paul Alexander; Jarno Riikonen; Henrikki Santti; Arnav Agarwal; Neera Bhatnagar; Philipp Dahm; Victor Montori; Gordon H Guyatt; Kari A O Tikkinen

doi:10.3322/caac.21272

Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis

CA Cancer J Clin. 2015 May-Jun;65(3):239-51. doi: 10.3322/caac.21272. Epub 2015 Mar 12.

Authors

Affiliations

¹ Endourology Fellow, Division of Urology, Department of Surgery, Western University, London, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Woodstock General Hospital, Woodstock, ON, Canada.
² Research Fellow, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
³ Doctoral Candidate, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
⁴ Consultant, Department of Urology, Tampere University Hospital, Tampere, Finland.
⁵ Consultant, Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶ Medical Student, Faculty of Medicine, University of Toronto, Toronto, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
⁷ Medical Librarian, Health Sciences Library, McMaster University, Hamilton, ON, Canada.
⁸ Professor, Department of Urology, University of Minnesota and Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
⁹ Professor, Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Departments of Medicine and Health Sciences Research, Mayo Clinic, Rochester, MN.
¹⁰ Distinguished Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹¹ Adjunct Professor, Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

PMID: 25772796
DOI: 10.3322/caac.21272

Abstract

Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.

Keywords: decision making; decision support techniques; patient education as topic; patient participation; patient preference; patient satisfaction; prostatic neoplasms.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Decision Support Techniques*
Humans
Male
Models, Statistical
Patient Participation*
Patient Satisfaction*
Prostatic Neoplasms / therapy*
Randomized Controlled Trials as Topic