School of Management, Hefei University of Technology, No.193 Tunxi Road, Hefei, People's Republic of China.
The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, People's Republic of China.
Support Care Cancer. 2021 Nov;29(11):6929-6941. doi: 10.1007/s00520-021-06184-y. Epub 2021 Apr 8.
The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types.
Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg's test, Egger's test, and Cochrane Collaboration's tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2.
A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being -0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies.
Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area.
CRD42020218991.
本研究旨在评估基于网络的决策辅助工具（WDAs）在不同决策类别和不同癌症类型的癌症相关临床护理方面的有效性。
文献检索采用高度包容性算法，在 MEDLINE、EMBASE 和 Cochrane Library 中搜索随机对照试验（RCTs），并从相关文章的参考文献中手动搜索合格研究。两名研究人员分别检查所选文章，并使用数据提取表提取有关研究的信息（例如决策类别、样本量和结果指标），并使用 Begg 检验、Egger 检验和 Cochrane 协作工具对纳入研究进行偏倚风险评估。通过 Review Manager 5.2 对 WDAs 对结果指标的综合效应进行荟萃分析。
共有 24 项 RCT 符合纳入标准，涉及 9846 名参与者。总体荟萃分析显示，WDAs 在癌症决策冲突、知识和做出明智选择方面具有统计学意义的效果，总体效应大小分别为-0.29（标准化均数差，SMD）、0.47（SMD）和 1.92（风险比，RR）。亚组分析显示，在决策冲突、知识、满意度、参与决策和筛查行为等指标中存在显著效果，但纳入研究存在一定程度的异质性和质量缺陷。
尽管我们的研究结果表明 WDAs 对某些癌症决策结果指标有一定的影响，但鉴于异质性和质量缺陷，这些结果应谨慎解释。目前还不能确定 WDAs 是否能有效优化癌症临床决策，在这方面还需要更多的努力。
PROSPERO 注册号：CRD42020218991。
