Ang Zen Yang, Kong Yuke-Lin, Md Nesran Zarith Nameyrra, Lee Shaun Wen Huey
Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia.
School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
BJU Int. 2025 Feb;135(2):222-234. doi: 10.1111/bju.16545. Epub 2024 Oct 14.
To review and compare the efficacy of different delivery modes of decision aids (DAs), including computer-based, print-based, multimedia-based, video-based, and website-based on decision-making outcomes for prostate cancer screening compared to usual care (UC) and among the delivery modes.
PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Advanced Search, and Turning Research Into Practice (TRIP) Database were systematically searched from inception to August 2023. The primary outcomes were knowledge level, knowledge scores, participation in shared decision-making (SDM), decisional conflict, and preference for SDM participation. Secondary outcomes were the proportion of subjects who underwent screening (actual screening utilisation) and the proportion of subjects who intended to be screened (intention to undergo screening). Network and pairwise meta-analyses were performed using random-effects models.
Seven systematic reviews were included. Network meta-analysis found that multimedia (relative risk [RR] 1.51, 95% confidence interval [CI] 1.02-2.24), print (RR 1.82, 95% CI 1.23-2.69), and website-based (RR 1.99, 95% CI 1.32-3.01) DAs significantly increased participation in SDM compared to the computer-based DA. There was a significant reduction in the actual screening utilisation in the computer DA arm compared to the other delivery modes. No significant differences between all delivery modes were noted on knowledge levels, knowledge scores, decisional conflict, preference for SDM participation, and intention to undergo screening. The highest mean surface under the cumulative ranking curve for all primary outcomes showed that website-based was the most effective delivery mode, followed by print-based DA. The pairwise meta-analysis showed a significant increase in participants' knowledge level, knowledge scores, a reduced intention to undergo screening and actual screening utilisation compared to UC.
The findings suggest that different types of DAs have varying levels of effectiveness in increasing knowledge level, knowledge scores, participation in SDM, and influencing screening behaviours. While website-based DA appeared the most effective, employing the print-based DA could be a practical solution in settings with limited resources.
回顾并比较不同形式的决策辅助工具（DAs）的效果，包括基于计算机的、基于印刷品的、基于多媒体的、基于视频的以及基于网站的，与常规护理（UC）相比，这些决策辅助工具对前列腺癌筛查决策结果的影响，以及在不同交付模式之间的比较。
系统检索了从创刊至2023年8月的PubMed、医学文摘数据库（EMBASE）、护理及相关健康文献累积索引（CINAHL）、谷歌高级搜索和将研究转化为实践（TRIP）数据库。主要结局包括知识水平、知识得分、参与共同决策（SDM）、决策冲突以及对参与SDM的偏好。次要结局包括接受筛查的受试者比例（实际筛查利用率）和打算接受筛查的受试者比例（接受筛查的意向）。使用随机效应模型进行网络和成对荟萃分析。
纳入了七项系统评价。网络荟萃分析发现，与基于计算机的决策辅助工具相比，多媒体（相对风险[RR] 1.51，95%置信区间[CI] 1.02 - 2.24）、印刷品（RR 1.82，95% CI 1.23 - 2.69）和基于网站的决策辅助工具（RR 1.99，95% CI 1.32 - 3.01）显著增加了对SDM的参与度。与其他交付模式相比，基于计算机的决策辅助工具组的实际筛查利用率显著降低。在知识水平、知识得分、决策冲突、对参与SDM的偏好以及接受筛查的意向方面，所有交付模式之间未发现显著差异。所有主要结局的累积排名曲线下的最高平均面积表明，基于网站的是最有效的交付模式，其次是基于印刷品的决策辅助工具。成对荟萃分析表明，与UC相比，参与者的知识水平、知识得分显著提高，接受筛查的意向和实际筛查利用率降低。
研究结果表明，不同类型的决策辅助工具在提高知识水平、知识得分、参与SDM以及影响筛查行为方面具有不同程度的有效性。虽然基于网站的决策辅助工具似乎最有效，但在资源有限的环境中，采用基于印刷品的决策辅助工具可能是一种切实可行的解决方案。
