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Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis.
OBJECTIVEThe aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies is to assess the effect of decision aids (DAs) in women aged 50 and below facing the decision to be screened for breast cancer.
SETTINGScreening for breast cancer.
INTERVENTIONDAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes.
ELIGIBLE STUDIESWe included published original, non-pilot, studies that assess the effect of DAs for breast cancer screening. We excluded the studies that evaluated only participation intention or actual uptake. The studies' risk of bias was assessed with the Cochrane Collaboration's tool for RCTs and the National Institutes of Health Quality Assessment Tool for non-RCTs.
PRIMARY AND SECONDARY OUTCOMESThe main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened.
RESULTSA total of 607 studies were identified, but only 3 RCTs and 1 before-after study were selected. The use of DAs increased the proportion of women making an informed decision by 14%, 95% CI (2% to 27%) and the proportion of women with adequate knowledge by 12%, 95% CI (7% to 16%). We observed heterogeneity among the studies in confidence in the decision. The meta-analysis of the RCTs showed a significant decrease in confidence in the decision and in intention to be screened.
CONCLUSIONSTools to aid decision making in screening for breast cancer improve knowledge and promote informed decision; however, we found divergent results on decisional conflict and confidence in the decision. Under the current paradigm change, which favours informed choice rather than maximising uptake, more research is necessary for the improvement of DAs.
Department of Basic Medical Sciences, University of Lleida-IRBLLEIDA, Lleida, Spain. Research Group on Economic Evaluation and Health (GRAES), Reus, Spain.,
Research Group on Economic Evaluation and Health (GRAES), Reus, Spain. Department of Economics, University Rovira i Virgili, Reus, Spain. Research Centre on Industrial and Public Economics (CREIP), Reus, Spain.,
Research Group on Economic Evaluation and Health (GRAES), Reus, Spain. Department of Economics, University Rovira i Virgili, Reus, Spain.,
Lleida Biomedical Research Institute (IRBLLEIDA), Lleida, Spain.,
Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Spain.,
Department of Basic Medical Sciences, University of Lleida-IRBLLEIDA, Lleida, Spain. Research Group on Economic Evaluation and Health (GRAES), Reus, Spain. Department of Economics, University Rovira i Virgili, Reus, Spain. Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.
MeSHAccess to Information
Decision Support Techniques
Early Detection of Cancer
Health Knowledge, Attitudes, Practice
Outcome Assessment (Health Care)
Patient Education as Topic
Pub Type(s)Journal Article