Effects of decision aids on breast reconstruction: A systematic review and meta‐analysis of randomised controlled trials

Abstract

Aims and Objectives:To systematically evaluate the effects of decision aids for women facing breast reconstruction decision on decision conflict, decision regret, knowledge, satisfaction, anxiety and depression.Background: Breast reconstruction decision is not good or bad and should be guided by clinical evidence and patient preferences. Decision aids can increase the patient's decision-making enthusiasm and ability, improve the quality of decision and promote shared decision-making between patients and medical staff.Design: Systematic review and meta-analysis.Methods: Eight databases were conducted from the establishment of the database until October 2021. The PRISMA checklist was selected for analysis in this paper. The meta-analysis was conducted in Review Manager 5.3. The quality of the studies was assessed using the Cochrane risk-of-bias tool. The result is decision conflict, decision regret, knowledge and other secondary outcomes. Sensitivity analysis and subgroup analysis were also conducted.Results: A total of twelve randomised controlled trials (RCTs) were included in the systematic review and meta-analysis. Meta-analysis revealed that decision aids could significantly reduce decision conflict and decision regret, improve knowledge, satisfaction and depression and had no influence on anxiety. Conclusions:The results of the systematic review and meta-analysis reviewed the positive effect of decision aids on the decision-making of women facing postmastectomy breast reconstruction. In the future, more well-designed RCTs are needed to confirm the effects of decision aids on the decision-making of breast reconstruction and nurses should be encouraged to take part in the development of decision aids in accordance with strict standards and apply them to breast cancer patients considering postmastectomy breast reconstruction. Relevance to clinical practice:Our study provides evidence for the effectiveness of decision aids on breast reconstruction and points to the important role of healthcare providers in the use of decision aids and in facilitating shared decision-making.

Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…In line with the results of a previous meta-analysis [26], web-based decision aids reduced decision conflict. Decision conflicts were as high as 45.68 (SD 23.40) among women who were newly diagnosed with early-stage BC in China [47].…”

“…This review also did not include the effects of decision aids on outcome indicators such as psychologically relevant outcomes. Yang et al [ 26 ] conducted a meta-analysis exploring the effects of decision aids on decision-making in PMBR; however, the authors did not compare whether different forms of decision aids would have different effects. Zhao et al [ 27 ] conducted a scoping review with the aim of reviewing, comparing, and discussing the current incorporation of the adverse effects of BC treatments into decision aids and examined how web-based decision aids personalized BC treatment decision-making tools in patient–health care provider communication, clinician decision-making processes, and shared decision-making, as yet unassessed patient outcomes (eg, knowledge and anxiety).…”

Decision aids for promoting shared decision‐making: A review of systematic reviews

“…Furthermore, DAs favorably affect clinical outcomes by enhancing risk perception accuracy (Stacey, Légaré, Lewis, Barry, et al, 2017; van Weert et al, 2016) and adherence (Nathan et al, 2016; Paskins et al, 2020; Song et al, 2022; Torres Roldan et al, 2021). The findings of some studies indicated that the implementation of DA interventions resulted in significant improvements in patient satisfaction (Berlin et al, 2019; Collée et al, 2020; Grüne et al, 2021; Staszewska et al, 2017; Tong et al, 2021; Wieringa et al, 2019; Yang et al, 2022), health (Grüne et al, 2021; Staszewska et al, 2017), and emotional (Staszewska et al, 2017; Violette et al, 2015; Vromans, Tenfelde, et al, 2019) outcomes.…”

“…SRs include various medical disciplines such as oncology (Martínez‐Alonso et al, 2017), chronic illness management (Wieringa et al, 2019), surgical interventions (Pacheco‐Brousseau et al, 2021), obstetrics and gynecology (Whybrow et al, 2022), and geriatric care (van Weert et al, 2016). Across all domains, the literature consistently highlights favorable results for patients, including improved knowledge (O'Connor et al, 2007), increased participation in decision‐making (Scalia et al, 2019), reduced decision conflict (Yang et al, 2022), and improved accuracy of risk perception in preventative treatments (Stacey, Légaré, Lewis, Barry, et al, 2017). Healthcare provider‐related outcomes include enhanced satisfaction (Yung et al, 2021), increased consultation length (Coronado‐Vázquez et al, 2019), and reduced decision conflict (Dobler et al, 2019).…”

“I don't know if I understood the whole process from the beginning”: A photo-elicitation exploration of the experience of mastectomy and breast reconstruction decision making

“…There is a clear need to improve communication between healthcare professionals and breast cancer patients, this should involve both improved training for healthcare professionals and better implementation of tools to support decision making. Breast cancer decision aids are available, and evidence suggests they can improve decision related outcomes for patients by reducing decisional conflict and increasing knowledge and satisfaction [ 24 ]. The barriers and facilitators to embedding the use of decision aids in patient care need to be better understood to support their successful implementation.…”