Baptista Sofia, Teles Sampaio Elvira, Heleno Bruno, Azevedo Luís Filipe, Martins Carlos
Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Serpa Pinto Family Health Unit, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal.
J Med Internet Res. 2018 Jun 26;20(6):e228. doi: 10.2196/jmir.9070.
Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict.
This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids.
We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR).
Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD -7.07%; 95% CI -9.44 to -4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD -0.50; 95% CI -0.88 to -0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25).
According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men.
前列腺癌是男性癌症的主要病因。由于前列腺癌筛查是一个存在争议的问题，该领域的许多专家都支持使用经过验证的决策辅助工具进行共同决策，这些工具可以以不同格式呈现（如书面、多媒体、网络）。近期研究得出结论，决策辅助工具可提高知识水平并减少决策冲突。
本荟萃分析旨在研究与常规护理及其他格式的决策辅助工具相比，使用基于网络的决策辅助工具对男性前列腺癌筛查决策的影响。
我们检索了截至2016年11月的PubMed、CINAHL、PsycINFO和Cochrane CENTRAL数据库。该检索确定了随机对照试验，这些试验评估了用于进行前列腺癌筛查决策的男性基于网络的决策辅助工具，并报告了决策质量结果。两名审阅者独立筛选文献以确定纳入标准、提取数据并评估偏倚风险。使用随机效应模型，采用均数差（MD）、标准化均数差（SMD）和相对危险度（RR）进行荟萃分析以汇总结果。
在2406条独特文献中，7项随机对照试验符合纳入标准。对于偏倚风险，由于报告不充分，选择性结果报告和参与者/人员盲法大多被评为不清楚。基于七个项目，两项研究在一个项目上存在高偏倚风险。与常规护理相比，基于网络的决策辅助工具增加了知识（SMD 0.46；95%CI 0.18 - 0.75），减少了决策冲突（MD -7.07%；95%CI -9.44至 -4.71），并降低了从业者在决策过程中的控制作用（RR 0.50；95%CI 0.31 - 0.81）。与印刷版决策辅助工具相比，基于网络的决策辅助工具在知识、决策冲突以及参与决策或筛查行为方面没有差异。与视频决策辅助工具相比，基于网络的决策辅助工具显示平均知识得分较低（SMD -0.50；95%CI -0.88至 -0.12），前列腺特异性抗原筛查略有减少（RR 1.12；95%CI 1.01 - 1.25）。
根据该分析，对于所评估的决策质量结果，基于网络的决策辅助工具与其他格式（如印刷版、视频）表现相似。网络的低成本、易获取性、可用性和匿名性可能有利于增加男性获取支持前列腺癌筛查决策的决策辅助工具的机会。
