Woodstock, Canada. Introduction & Objectives: Prostate cancer screening decision is preference-sensitive. Decision aids may facilitate screening decision by.
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Decision aids for prostate cancer screening choice: A systematic review and meta-analysis Eur Urol Suppl 2018; 17(2);e381
Riikonen J. 1 , Guyatt G. 2 , Kilpeläinen T. 3 , Craigie S. 2 , Agarwal A. 4 , Agoritsas T. 2 , Couban R. 5 , Dahm P. 6 , Järvinen P. 3 , Montori V. 7 , Power N. 8 , Richard P. 9 , Rutanen J. 10 , Santti H. 11 , Tailly T. 12 , Violette P. 13 , Zhou Q. 2 , Tikkinen K. 3 1
Tampere University Hospital, Dept. of Urology, Tampere, Finland, 2McMaster University, Dept. of Health Research Methods, Evidence, and
Impact, Hamilton, Canada, 3Helsinki University Hospital and University of Helsinki, Dept. of Urology, Helsinki, Finland, 4University of Toronto, Faculty of Medicine, Toronto, Canada, 5McMaster University, Dept. of Anesthesiology, Hamilton, Canada, 6Minneapolis Veterans Administration Health Care System and University of Minnesota, Dept. of Urology, Minneapolis, United States of America, 7Mayo Clinic, Knowledge and Evaluation Research Unit, Rochester, United States of America, 8Western University, Dept. of Urology, London, Canada, 9Sherbrooke University, Dept. of Surgery, Sherbrooke, Canada, 10Tampere University Hospital, Dept. of Internal Medicine, Tampere, Finland, 11Helsinki University Hospital, Dept. of Urology, Helsinki, Finland, 12University Hospital Ghent, Dept. of Urology, Ghent, Belgium, 13Woodstock General Hospital, Dept. of Surgery, Woodstock, Canada
Introduction & Objectives: Prostate cancer screening decision is preference-sensitive. Decision aids may facilitate screening decision by providing information on the risks and benefits of screening. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that addressed the impact of decision aids on decisional outcomes and the men’s screening decision.
Materials & Methods: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Central Registers of Controlled Trials and Systematic Reviews up to June 2017. Screening of articles, data extraction, and assessment of risk of bias using a modified Cochrane risk of bias tool and quality of decision aids using IPDAS instrument were performed independently and in duplicate. We asked authors to verify the accuracy of our extracted data. From the trials in which appropriate decision aids were compared to usual care, we abstracted screening related data: Knowledge about prostate cancer screening, screening discussion during clinical encounter, decisional conflict, and screening decision. We analyzed effects using the DerSimonian-Laird’s random-effects inverse variance method for continuous outcomes, reported as standardized mean differences with 95% confidence intervals (CI), and for dichotomous outcomes using the Cochran-Mantel-Haenszel method (relative risk and 95% CI).
Results: Of 7,825 reports from 6 databases, 19 RCTs proved eligible (n=12,662). In all 19 studies, allocation sequence was adequately generated, in almost half allocation was adequately concealed (47%) and data collectors blinded (42%). We were able to evaluate 9 decision aids: They reported the aim (100%) and the consequence of screening (89%) well, however, only two (22%) reported chances of having true or false negative test result, or the next step if screening test is negative. None of the aids were designed to facilitate shared decision making between patients and physicians. In the pooled analyses (Figure), decision aids moderately increased knowledge, and demonstrated a small decrease in decisional
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conflict. Decision aids had no effect on discussion about screening but resulted in a small decrease in willingness to undergo screening.
Conclusions: Moderate quality evidence suggests modest impacts of existing decision aids. Work in this area would benefit from decision aids that not only provide education to patients, but also promote shared decision making in the patient-physician encounter.
Eur Urol Suppl 2018; 17(2);e382
