medwireNews: Current decision aids probably have no influence on whether physicians and patients discuss prostate cancer screening or decide to undergo screening, according to a systematic review and meta-analysis.
“Randomized clinical trials have failed to provide compelling evidence for the use of decision aids for men contemplating prostate cancer screening,” write Kari Tikkinen (Helsinki University Hospital, Finland) and colleagues, who examined data from 19 trials with 12,781 participants.
The researchers compared the use of decision aids with usual care in which clinicians provided no formal, structured presentation of information. Decision aids were defined as materials that helped men to make individual choices and included information on the association of screening with important outcomes, such as the risk for dying.
Reporting in JAMA Internal Medicine, the researchers say that decision aids are unlikely to influence whether physicians and patients discuss prostate cancer screening, with discussions on the topic taking place at a similar frequency among men managed with usual care and decision aids, at a median of 47% versus 52%.
A pooled analysis of data from six studies found no association between decision aids and physician–patient discussions, with a nonsignificant risk ratio (RR) of 1.12, although this outcome was based on low quality evidence, the investigators observe.
They note that the decision aids were distributed to patients at different times in these studies, from 1 hour before the visit to 1–2 weeks ahead, and in one study, 8 months before the patients’ visits.
Similarly, decision aids did not appear to influence a man’s decision to undergo prostate cancer screening, with screening chosen by a median of 49% of men in the usual care and decision aid groups. A pooled analysis of data from 13 studies again found no association for the use of decision aids with this decision, with a RR of 0.95, although again this evidence was judged as low quality, Tikkinen et al say.
However, the researchers reported that decision aids are “possibly” associated with improvement in knowledge with a significant RR of 1.38 , despite the evidence being judged as low quality, and “probably” associated with a small decrease in decisional conflict, based on moderate-quality evidence indicating an average 4.19 difference on a 100-point scale.
In an accompanying commentary, Laura Scherer (University of Colorado, Denver, USA) and Grace Lin (University of California, San Francisco, USA) observe: “Although we agree that these data do not provide a persuasive case for use of the [decision aids] included in the meta-analysis, it would be premature to conclude on the basis of these data that [decision aids] do not and could not affect prostate cancer screening decisions.”
The commentators say that decision aid designers and testers must now ensure they are both “giving patients the most important information,” and giving the decision aids to “the right people, in the right setting, and at the right moment,” as well as assessing whether key outcomes are determined using “validated and reliable measures.”
Scherer and Lin conclude: “Without such information, the true usefulness of [decision aids] to sustainably facilitate [shared decision making] and serve patients’ and clinicians’ goals and needs remains unknown.”
By Catherine Booth
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