Interventions that Facilitate Shared Decision-Making in Cancers with Active Surveillance as Treatment Option: a Systematic Review of Literature

Abstract

Purpose of review Medical decisions concerning active surveillance are complex, especially when evidence on superiority of one of the treatments is lacking. Decision aids have been developed to facilitate shared decision-making on whether to pursue an active surveillance strategy. However, it is unclear how these decision aids are designed and which outcomes are considered relevant. The purpose of this study is to systematically review all decision aids in the field of oncological active surveillance strategies and outcomes used by authors to assess their efficacy. Recent findings A search was performed in Embase, Medline, Web of Science, Cochrane, PsycINFO Ovid and Google Scholar until June 2019. Eligible studies concerned interventions aiming to facilitate shared decision-making for patients confronted with several treatment alternatives, with active surveillance being one of the treatment alternatives. Twenty-three eligible articles were included. Twenty-one articles included patients with prostate cancer, one with thyroid cancer and one with ovarian cancer. Interventions mostly consisted of an interactive web-based decision aid format. After categorization of outcomes, seven main groups were identified: knowledge, involvement in decision-making, decisional conflict, treatment preference, decision regret, anxiety and health-related outcomes. Summary Although active surveillance has been implemented for several malignancies, interventions that facilitate shared decision-making between active surveillance and other equally effective treatment alternatives are scarce. Future research should focus on developing interventions for malignancies like rectal cancer and oesophageal cancer as well. The efficacy of interventions is mostly assessed using short-term outcomes.

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.…”

“…Some SRs found that DAs improve healthcare decision‐making and reduce anxiety and depression in patients (Collée et al, 2020; Spronk et al, 2019; Violette et al, 2015; Vromans, Tenfelde, et al, 2019) This suggests that DAs help improve the overall well‐being of patients, in addition to enhancing their ability to make effective decisions. The findings of these investigations need to be confirmed by additional research and a study on the potential mechanisms by which DAs may positively impact mental health outcomes should be conducted.…”

“…Comparisons with the ODSF revealed that most of the included reviews identified decisional needs, such as decision conflict (Wieringa et al, 2019), inadequate knowledge and expectations (Collée et al, 2020), support and resources, decision type (Violette et al, 2015), and personal characteristics. DAs can be used as support Note: #, decrease;…”

What interventions affect the psychosocial burden experienced by prostate cancer patients undergoing active surveillance? A scoping review

“…It should not merely be selected to avoid treatment-related complications. Thus, it is recommended that shared decision-making techniques and decision aids be used to support careful deliberation about AS [42][43][44].…”

Shared Decision Making for Radioiodine Therapy and the Actual Pattern of Care in Intermediate-Risk Differentiated Thyroid Carcinoma

“…thyroglobulin). In view of this situation, participatory decision making between physicians and informed patients, which is in principle required today anyway, is of particular importance (5,37). In the absence of strong evidence, the patient must be sufficiently informed about the evidence available and its background.…”