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Table 1 Overview of the articles

From: Decision aids on breast conserving surgery for early stage breast cancer patients: a systematic review

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)
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)
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)
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)
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
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
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
  1. BC breast cancer, DA decision aids, BCS breast-conserving surgery, MRM modified radical mastectomy, BR breast reconstruction, MT mastectomy