Table 1 Overview of the articles
Authors | Year | Country | Design | Sample | Intervention | Control | Measurement tools | Outcomes | Qualsyst |
|---|---|---|---|---|---|---|---|---|---|
Lam [11] | 2013 | China | Randomized control trial | 276 patients with early stage BC DA: 138 patients Control: 138 patients | Take-home booklet | The standard information booklet | Treatment decision-making difficulties and decisional conflict scale, knowledge scale, decision regret, Hospital Anxiety and Depression Scale (HADS)-Anxiety subscale and HADS-Depression subscale, decision regret | Choice of surgery did not differ between the DA and control arms. (BCS, MRM or MRM + BR/MRM or MRM + BR) The DA group had lower decisional conflict scores 1 week after consultation (P < 0.016), lower decision regret scores 4 (P < 0.026) and 10 months (P < 0.014) after surgery and lower depression scores 10 months after surgery (P < 0.001) | 0.89 |
Jibaja-Weiss [10] | 2011 | USA | Randomized control trial | 76 patients with early stage BC (I–IIIA) DA: 40 patients Control: 36 patients | An entertainment-based decision aid for breast cancer treatment along with usual care | Usual care only | A questionnaire for evaluating breast cancer knowledge, Satisfaction with Decision Scale (SWD), Satisfaction with the Process of Making a Treatment Decision scale (SWDMP), low-literacy version of the Decisional Conflict Scale | Patients in DA group prefer to MRM (59.5% vs. 39.5%, P = 0.018) than BCS (40.5% vs. 50.0%). (BCS or MRM) DA group showed a significant improvement in knowledge at the pre-surgery assessment (P < 0.001). Both groups showed decreased decisional conflict over the assessment periods (P < 0.001) | 0.57 |
Whelan [15] | 2004 | Canada | Randomized control trial | 201 patients with stage I or II BC and 20 surgeons DA: 94 patients and 10 surgeons Control: 107 patients and 10 surgeons | Decision board (written and visual information) Takes 20 min | Usual consultation style without using the decision board | A 44-item questionnaire for patient knowledge, decisional conflict scale, effective decision-making subscale of the decisional conflict scale, the Spielberger State Anxiety Inventory and the Centre for Epidemiologic Studies Depression scale | Patients in DA group were more likely to choose BCS (94% vs. 76%, P = 0.03). (BCS or MT) The DA group had higher knowledge scores about their treatment options (66.9 vs. 58.7; P < 0.001), had less decisional conflict (1.40 vs. 1.62, P = 0.02), and were more satisfied with decision making (4.50 vs. 4.32, P = 0.05) | 0.75 |
Street [13] | 1995 | USA | Randomized control trial | 60 patients with stage I or II BC DA: 30 patients Control: 30 patients | Multimedia program (including text, graphic display, audio narration, music, and audio–video clips) Takes 30–45 min | An 8-page brochure, Care of Patients with Early Breast Cancer Takes 15–20 min | An 11-item, multiple choice test for knowledge about BC treatment, an 8-item instrument for patients’ optimism, behavioral and self-report measures for patient involvement and physician communication, modified Perceived Involvement in Care Scale (PICS), modified Perceived Decision Control (PDC), 5-item doctor facilitation subscale of PICS | More patients educated with the computer chose BCS (76%) than did those reading the brochure (58%). (BCS or MT) Patients using the computer program scored higher in the knowledge test (mean, 82.6%; SD, 11.58%) after the intervention than did patients reading the brochure (mean, 76.4%; SD, 13.77%). The only variable predicting a patient’s optimism was knowledge (r = 0.31, P < 0.01) | 0.61 |
Wilkins [16] | 2006 | USA | Nonrandomized trial with concurrent control | 101 patients with stage I or II BC DA: 52 patients Control: 49 patients | Educational video Takes 60 min | Written educational materials | Autonomy and Information-Seeking Preferences, Self-Efficacy to Communicate with Physician/Manage Disease, Knowledge about Breast Cancer, State-Trait Anxiety Inventory, Perceived Involvement in Care, Satisfaction with Decision | 25% of people who saw the video chose mastectomy compared to 14% of those who did not see the video (P = 0.18; OR = 2.00, 95%CI 0.72–5.53). (BCS or MT) No statistically significant differences between the 2 groups measured with all the scales | 0.82 |
Molenaar [12] | 2001 | the Netherlands | Nonrandomized trial with concurrent control | 180 patients with stage I or II BC DA: 92 patients Control: 88 patients | Interactive Breast Cancer CDROM Takes 70 min | Standard care including oral information and brochures | A 4-item scale for satisfaction with the decision-making process, 3 out of 4 items of the “effective decision-making” subscale of the DCS for satisfaction with the decision, the MOS20 and the EORTC QLQ-BR23 | No difference between the CDROM and standard care condition in the treatment decision made. Most patients in both conditions selected BCS (CDROM: 75%; standard care 68%). (BCS or MT) CDROM patients expressed more satisfaction with information, the decision-making process, and communication. CDROM patients reported better physical functioning, less pain and fewer arm symptoms | 0.86 |
Whelan [14] | 1999 | Canada | Nonrandomized trial with historical control | patients with clinical stage I or II BC and 7 surgeons DA: 175 patients and 7 surgeons Control: 194 patients | The surgical Decision Board Takes 20 min | Before DA | A 6-point Likert scale for patient preference, questionnaire for general acceptability of the decision aid, a 14-statement response for patient comprehension, a 5-point Likert scale for patient satisfaction with information and decision-making | The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% vs. 73%, P = 0.001). (BCS or MT) 98% patients using the Decision Board reported that the Decision Board was easy to understand, and 81% indicated that it helped them make decisions. Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations | 0.64 |