O'Brien Mary Ann, Whelan Timothy J, Villasis-Keever Miguel, Gafni Amiram, Charles Cathy, Roberts Robin, Schiff Susan, Cai Wenjie
Supportive Cancer Care Research Unit, Juravinski Cancer Centre and McMaster University, 699 Concession St, Room 4-204, Hamilton, Ontario L8V 5C2, Canada.
J Clin Oncol. 2009 Feb 20;27(6):974-85. doi: 10.1200/JCO.2007.16.0101. Epub 2009 Jan 5.
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.
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.
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.
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.
决策辅助工具（DAs）已被开发出来，以改善医护人员与患者之间的沟通，并让患者参与有关其医疗保健的决策。由于在传达关于预后的复杂信息以及现有治疗的适度益处方面存在问题，与癌症相关的决策可能会很困难。我们对与癌症相关的决策辅助工具进行了系统评价。
纳入了关于筛查、预防和治疗决策的与癌症相关的决策辅助工具的随机对照试验（RCTs）。我们完成了全面的文献检索，并进行了定性和定量分析。我们还进行了元回归以探索效应估计的异质性。
我们在筛查（n = 22项试验）或预防/治疗（n = 12项试验）背景下确定了34项决策辅助工具的随机对照试验。与常规做法相比，决策辅助工具显著提高了对筛查选项的了解（加权平均效应大小，0.50；95%CI，0.27至0.73；P <.0001）。在预防/治疗选项方面也发现了类似的知识效应（加权平均效应大小，0.50；95%CI，0.31至0.70；P <.0001）。总体而言，在大多数试验中一般焦虑并未增加，在筛查背景下显著降低。决策冲突总体上有所减少，但在分别分析筛查和预防/治疗研究时并未减少。不同类型的决策辅助工具之间差异不大。
与常规做法相比，与癌症相关的决策辅助工具在增加患者知识方面是有效的，且不会增加焦虑，尤其是在癌症筛查领域。需要进一步研究以确定决策辅助工具在预防和治疗背景下的有效性。
