Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Eur Urol Focus. 2022 May;8(3):851-869. doi: 10.1016/j.euf.2021.04.013. Epub 2021 May 10.
Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs.
To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities.
This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A systematic literature search (MedLine, Cochrane Library, Web of Science Core Collection, and CCMed) was conducted to identify DAs for treatment decisions for patients with prostate, renal, or bladder cancer. All studies reporting on the development or evaluation of DAs were included. The DAs were examined based on the International Patient Decision Aid Standards (IPDAS) and the evaluation studies were compared in accordance with Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE).
The literature search identified 1995 potentially relevant publications. Thirty-two studies reporting on 25 DAs met the inclusion criteria. Twenty-two DAs address prostate cancer, two renal tumor, and one bladder cancer. In the majority of DAs (n = 20), patients can enter individual data. A few (n = 6) DAs allow for personalization using a risk-adapted presentation of treatment options. The percentage of IPDAS criteria met in DAs ranged between 50% and 100% (median 87.5%), and the studies' adherence to the SUNDAE checklist was between 62% and 96% (median 86.6%). Evaluation studies suggest that interventions are likely efficacious. However, a preliminary meta-analysis revealed no significant difference between "DA" and "usual care" for decisional conflict or decisional regret.
This review highlights that a number of well-developed DAs exist in urology. However, there is a need for specific instruments targeting kidney and bladder cancer. Personalization of tools and adherence to international standards of DAs should be further improved.
The majority of uro-oncological decision aids target prostate cancer, whereas fewer address kidney or bladder cancer. The quality of the existing instruments is high, but can be increased further to better address specific needs of individual patients.
决策辅助工具（DA）旨在支持患者参与复杂治疗决策的共同决策过程。为了改善泌尿外科的以患者为中心的护理，评估现有的 DA 的可用性和质量至关重要。
评估针对最常见的泌尿肿瘤实体的患者的现有 DA 的质量。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。进行了系统的文献检索（MedLine、Cochrane 图书馆、Web of Science 核心合集和 CCMed），以确定针对前列腺癌、肾癌或膀胱癌患者的治疗决策的 DA。纳入所有报告 DA 的开发或评估的研究。根据国际患者决策辅助工具标准（IPDAS）检查 DA，并根据患者决策辅助工具评估的通用报告标准（SUNDAE）比较评估研究。
文献检索确定了 1995 篇可能相关的出版物。32 项研究报告了 25 项符合纳入标准的 DA。22 项 DA 针对前列腺癌，2 项针对肾肿瘤，1 项针对膀胱癌。在大多数 DA（n = 20）中，患者可以输入个人数据。少数（n = 6）DA 允许使用治疗方案的风险适应呈现进行个性化设置。DA 符合 IPDAS 标准的百分比在 50%至 100%之间（中位数 87.5%），研究对 SUNDAE 清单的遵守程度在 62%至 96%之间（中位数 86.6%）。评估研究表明干预措施可能有效。然而，初步的荟萃分析显示，在决策冲突或决策后悔方面，“DA”与“常规护理”之间没有显著差异。
本综述强调，泌尿科存在许多开发良好的 DA。然而，需要针对肾癌和膀胱癌的特定工具。工具的个性化和对 DA 的国际标准的遵守应进一步提高。
大多数泌尿肿瘤决策辅助工具针对前列腺癌，而针对肾癌或膀胱癌的工具较少。现有工具的质量很高，但可以进一步提高，以更好地满足个别患者的特定需求。
