Williams Tokoya, Fine Keenan, Duckworth Emily, Adam Tarifa, Bozigar Caden, McFarland Annie, Nguyen Antoinette, Coles Brigid M, Galiano Robert D
Northwestern University Feinberg School of Medicine, 259 East Erie Street, Suite 2060, Chicago, IL, 60611, USA.
University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Breast Cancer Res Treat. 2025 Aug;213(1):1-14. doi: 10.1007/s10549-025-07752-0. Epub 2025 Jun 30.
Around 310,000 new cases of breast cancer (BC) are diagnosed each year. Complex treatment options often overwhelm patients. Patient decision aids (PDAs) assist in surgical decision-making, but reviews of their quality and efficacy are limited. This study systematically reviews breast surgery (BS) and breast reconstruction (BR) PDAs using the International Patient Decision Aid Standards and Cochrane tools to identify gaps and provide evidence-based recommendations.
A systematic review following PRISMA guidelines examined the impact of PDAs on decision-making for BC patients considering BS and BR. From 1198 articles, 35 met the inclusion criteria. Data on PDA components, study design, and results were extracted, focusing on decisional conflict and anxiety, measured by the Decisional Conflict Scale (DCS) and the State-Trait Anxiety Inventory (STAI). PDA quality and study design were assessed using Cochrane, IPDASi, and ROBINS-I tools.
Eight studies evaluated the effect of PDAs on decisional conflict. The pooled mean difference of 3.08 points (95% CI: - 0.62 to 6.79, p = 0.10) favored the PDA group but was not statistically significant. Two studies, however, reported notable reductions in decisional conflict with effect sizes of 13.50 and 12.80 points, respectively. The pooled effect size of PDA exposure on patient anxiety was 1.93 (95% CI: - 0.46 to 4.31) in favor of PDAs, but was not statistically significant (p = 0.11). The evaluation of PDA content quality revealed variable results.
BS and BR PDAs were not found to significantly reduce decisional conflict and anxiety in breast cancer patients. Standardized, evidence-based tools are needed.
每年约有31万例新发乳腺癌病例被诊断出来。复杂的治疗方案常常让患者应接不暇。患者决策辅助工具（PDA）有助于手术决策，但对其质量和疗效的综述有限。本研究使用国际患者决策辅助标准和Cochrane工具对乳房手术（BS）和乳房重建（BR）的PDA进行系统综述，以找出差距并提供循证建议。
按照PRISMA指南进行系统综述，考察PDA对考虑进行BS和BR的乳腺癌患者决策的影响。从1198篇文章中，35篇符合纳入标准。提取了关于PDA组成部分、研究设计和结果的数据，重点关注通过决策冲突量表（DCS）和状态-特质焦虑量表（STAI）测量的决策冲突和焦虑。使用Cochrane、IPDASi和ROBINS-I工具评估PDA质量和研究设计。
八项研究评估了PDA对决策冲突的影响。合并平均差异为3.08分（95%CI：-0.62至6.79，p = 0.10），有利于PDA组，但无统计学意义。然而，两项研究报告决策冲突显著降低，效应量分别为13.50分和12.80分。PDA暴露对患者焦虑的合并效应量为1.93（95%CI：-0.46至4.31），有利于PDA，但无统计学意义（p = 0.11）。对PDA内容质量的评估结果不一。
未发现BS和BR的PDA能显著降低乳腺癌患者的决策冲突和焦虑。需要标准化的循证工具。
