Originally published as JCO Early Release 10.1200/JCO.2007.16.0101 on January 5 2009

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Are Cancer-Related Decision Aids Effective? A Systematic Review and Meta-Analysis

From the Supportive Cancer Care Research Unit, Juravinski Cancer Centre and McMaster University; Department of Oncology; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada; and the Clinical Epidemiology Research Unit, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.

Corresponding author: Mary Ann O'Brien, MSc, BHSc, Supportive Cancer Care Research Unit, Juravinski Cancer Centre, 699 Concession St, Room 4-204, Hamilton, Ontario L8V 5C2, Canada; e-mail: maobrien{at}mcmaster.ca.

Purpose Decision aids (DAs) have been developed to improve communication between health professionals and patients, and to involve patients in decisions about their health care. Cancer-related decisions can be difficult due to problems in communicating complex information about prognosis and the modest benefits of available treatments. We conducted a systematic review of cancer-related DAs.

Methods Randomized controlled trials (RCTs) of cancer-related DAs about screening, prevention, and treatment decision making were included. We completed a comprehensive literature search and conducted both qualitative and quantitative analyses. We also conducted a meta regression to explore heterogeneity of effect estimates.

Results We identified 34 RCTs of DAs in a screening (n = 22 trials) or preventive/treatment (n = 12 trials) context. DAs significantly improved knowledge about screening options when compared to usual practice (weighted average effect size, 0.50; 95% CI, 0.27 to 0.73; P < .0001). A similar effect on knowledge was also found for preventive/treatment options (weighted average effect size, 0.50; 95% CI, 0.31 to 0.70; P < .0001). Overall, general anxiety was not increased in most trials and was significantly reduced in a screening context. Decisional conflict was reduced overall but not when screening and preventive/treatment studies were analyzed separately. There were few differences between different types of DAs.

Conclusion Cancer-related DAs are effective in increasing patient knowledge compared with usual practice without increasing anxiety particularly in the area of cancer screening. Further research is needed to determine the effectiveness of DAs in the prevention and treatment context.

M.A.O. is the recipient of doctoral fellowships from the Canadian Breast Cancer Foundation (Ontario region) and the Breast Cancer Research Program, US Department of Defense.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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