Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain.
Service of Preventive Medicine, Hospital Universitario San Cecilio, Granada, Spain.
Health Expect. 2023 Jun;26(3):1019-1038. doi: 10.1111/hex.13753. Epub 2023 Apr 5.
In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences by gender.
To systematically analyse recommendations concerning shared decision-making in CPGs and consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial).
We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8 guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions.
CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021.
Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed.
A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12 consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer guidelines (p < .001).
We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected.
The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients' preferences and shared decision-making in cancer care.
在癌症护理中，临床实践指南（CPG）和共识声明中促进和实施共享决策可能因性别而异。
系统分析仅针对男性（前列腺）和女性（子宫内膜）最常见癌症的 CPG 和共识声明中关于共享决策的建议。
我们在 PROSPERO（ID：RD42021241127）前瞻性注册了该方案。我们独立地由两名审查员对 MEDLINE、EMBASE、Web of Science、Scopus 和在线资源（8 个指南数据库和 65 个专业协会网站）进行了搜索，无语言限制。
纳入了 2015 年 1 月至 2021 年 8 月期间关于前列腺和子宫内膜癌诊断或治疗的 CPG 和共识声明。
使用先前开发的 31 项工具对质量评估进行评估，并分析了两种癌症之间的差异。
共有 176 份文件符合纳入标准，其中 97 份为前列腺癌（84 份 CPG 和 13 份共识声明），79 份为子宫内膜癌（67 份 CPG 和 12 份共识声明）。与子宫内膜癌指南相比，前列腺癌指南更常推荐共享决策（46/97 比 13/79，47.4%比 16.5%；p<0.001）。与前列腺癌指南（平均 2.14 项，标准差 3.45）相比，子宫内膜癌指南对共享决策 31 项工具的依从性较低（平均 0.48 项，标准差 1.29）（p<0.001）。关于实施共享决策的建议，仅在 3 份（3.8%）子宫内膜癌指南和 16 份（16.5%）前列腺癌指南中报告（p<0.001）。
我们观察到了显著的性别偏见，因为与子宫内膜癌指南相比，前列腺癌指南中系统地更常推荐共享决策。这些发现应该鼓励新的 CPG 和共识声明考虑在癌症护理中进行共享决策，以改善癌症护理，而不论受影响的性别如何。
这些发现可能为专业协会和政府提供信息，以更新和制定高质量的临床指南，以考虑癌症护理中的患者偏好和共享决策。
