The impact of decision aids in patients with colorectal cancer: a systematic review

Goldwag, Jenaya L.; Marsicovetere, Priscilla; Scalia, Peter; Johnson, Heather A.; Durand, Marie-Anne; Elwyn, Glyn; Ivatury, Srinivas J.

doi:10.1136/bmjopen-2018-028379

Cited by 21 publications

(19 citation statements)

References 37 publications

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“…Our results are in line with previous systematic reviews on CRC DAs in general 15 and CRC Decision Support Systems for stage IV 16 as both conclude that evidence for the quality of CRC DAs is too limited to recommend their use in clinical practice today. Additionally, conclusions can be drawn for the quality of communication in DAs between prostate, 12 breast 13 and CRC, as all reviews indicate that there are substantial differences in the communicative quality between individual DAs and overall quality seems to be low.…”

Section: Discussionsupporting

confidence: 92%

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Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

et al. 2021

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ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

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Section: Discussionsupporting

confidence: 92%

“…Currently, we are aware of only one systematic review that focusses on CRC DAs for treatment. However, this small review 15 only included three academically developed DAs. Another systematic review assessed the usefulness of metastatic CRC nomograms 16 (N=14).…”

Section: Introductionmentioning

confidence: 99%

Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

et al. 2021

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“…Health literacy is the ability to obtain, understand and use health information to actively participate in decision-making and navigate health services [ 21 ]. The findings from our study are in line with previous research which highlights the impact of limited health literacy on the publics’ ability to independently use a decision aid [ 22 ] and to make good decisions about their health [ 21 ]. The finding suggests that the information in the resource should be appropriately designed to include the use of plain language and avoid the use of technical jargon in order to be usable by all audiences.…”

Section: Discussionsupporting

confidence: 91%

User testing a patient information resource about potential complications of vaginally inserted synthetic mesh

et al. 2021

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Background Vaginal mesh implants are medical devices used in a number of operations to treat stress urinary incontinence and pelvic organ prolapse. Although many of these operations have delivered good outcomes, some women have experienced serious complications that have profoundly affected their quality of life. To ensure that evolving patient information is up-to-date, accurate and appropriate, the Transvaginal Mesh Oversight Group ‘user-tested’ a newly developed Scottish patient resource, the first to focus exclusively on the issue of complications. The aim of this research was to gather feedback on usability, content, language and presentation to inform the development of the resource from a user perspective. Methods The experience of using the patient resource was captured through semi-structured interviews that followed a ‘think-aloud’ protocol. The interviewer observed each participant as they went through the resource, asking questions and making field notes. Participants’ comments were then categorised using a validated model of user experience and subsequently analysed thematically. Results Thirteen people participated in the user testing interviews, including women with lived experience of mesh implants (n = 7), a convenience sample of staff working for Healthcare Improvement Scotland (n = 5) and a patient’s carer (n = 1). The majority of participants considered the resource as clear and helpful. Respondents reported that some presentational aspects promoted usability and understandability, including the use of a font that is easy to read, bullet lists, coloured headings and simple language. Barriers included the reliance on some technical language and an explicit anatomical diagram. Participants endorsed the valuable role of health professionals as co-mediators of patient information. Conclusions The findings illustrate the value of undertaking in-depth user-testing for patient information resources before their dissemination. The study highlighted how the direct guidance or navigation of a patient information resource by a health professional could increase its salience and accuracy of interpretation by patients, their families and carers. These insights may also be useful to other developers in improving patient information.

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“…The use of DA can help patients participate in the decisions to improve the quality of the decision-making process and the satisfaction with the chosen option. [ 10 ] Benefits from DA compared with usual care have already been described. DA increase knowledge regarding options and reduce the decisional conflict related to feeling uninformed.…”

Section: Introductionmentioning

confidence: 99%

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

et al. 2020

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Background: Shared decision making (SDM) is a process within the physician–patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients’ and health professionals’ satisfaction with the intervention. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool. Results: Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. Conclusions: DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.

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The impact of decision aids in patients with colorectal cancer: a systematic review

Cited by 21 publications

References 37 publications

Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

User testing a patient information resource about potential complications of vaginally inserted synthetic mesh

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

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