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Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis.

Abstract

OBJECTIVE

The 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.

SETTING

Screening for breast cancer.

INTERVENTION

DAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes.

ELIGIBLE STUDIES

We 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 OUTCOMES

The main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened.

RESULTS

A 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.

CONCLUSIONS

Tools 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.

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  • Authors+Show Affiliations

    ,

    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.

    Source

    BMJ open 7:10 2017 Oct 06 pg e016894

    MeSH

    Access to Information
    Adult
    Breast Neoplasms
    Choice Behavior
    Conflict (Psychology)
    Decision Making
    Decision Support Techniques
    Early Detection of Cancer
    Female
    Health Knowledge, Attitudes, Practice
    Humans
    Informed Consent
    Intention
    Mammography
    Mass Screening
    Middle Aged
    Outcome Assessment (Health Care)
    Patient Education as Topic
    Patient Participation
    Uncertainty

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    28988175

    Citation

    Martínez-Alonso, Montserrat, et al. "Assessment of the Effects of Decision Aids About Breast Cancer Screening: a Systematic Review and Meta-analysis." BMJ Open, vol. 7, no. 10, 2017, pp. e016894.
    Martínez-Alonso M, Carles-Lavila M, Pérez-Lacasta MJ, et al. Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. BMJ Open. 2017;7(10):e016894.
    Martínez-Alonso, M., Carles-Lavila, M., Pérez-Lacasta, M. J., Pons-Rodríguez, A., Garcia, M., & Rué, M. (2017). Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. BMJ Open, 7(10), pp. e016894. doi:10.1136/bmjopen-2017-016894.
    Martínez-Alonso M, et al. Assessment of the Effects of Decision Aids About Breast Cancer Screening: a Systematic Review and Meta-analysis. BMJ Open. 2017 Oct 6;7(10):e016894. PubMed PMID: 28988175.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. AU - Martínez-Alonso,Montserrat, AU - Carles-Lavila,Misericòrdia, AU - Pérez-Lacasta,Maria José, AU - Pons-Rodríguez,Anna, AU - Garcia,Montse, AU - Rué,Montserrat, AU - ,, Y1 - 2017/10/06/ PY - 2017/10/9/entrez PY - 2017/10/11/pubmed PY - 2018/6/2/medline KW - breast cancer KW - decision aid KW - mammography KW - screening KW - shared decision making SP - e016894 EP - e016894 JF - BMJ open JO - BMJ Open VL - 7 IS - 10 N2 - OBJECTIVE: The 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. SETTING: Screening for breast cancer. INTERVENTION: DAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes. ELIGIBLE STUDIES: We 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 OUTCOMES: The main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened. RESULTS: A 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. CONCLUSIONS: Tools 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. SN - 2044-6055 UR - https://wwww.unboundmedicine.com/medline/citation/28988175/Assessment_of_the_effects_of_decision_aids_about_breast_cancer_screening:_a_systematic_review_and_meta_analysis_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=28988175 DB - PRIME DP - Unbound Medicine ER -