Decision Aids for Prostate Cancer Screening Choice

A Systematic Review and Meta-analysis

Jarno M. Riikonen, Gordon H. Guyatt, Tuomas P. Kilpeläinen, Samantha Craigie, Arnav Agarwal, Thomas Agoritsas, Rachel Couban, Philipp Dahm, Petrus Järvinen, Victor Manuel Montori, Nicholas Power, Patrick O. Richard, Jarno Rutanen, Henrikki Santti, Thomas Tailly, Philippe D. Violette, Qi Zhou, Kari A.O. Tikkinen

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data Sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study Selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data Extraction and Synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main Outcomes and Measures: Knowledge, decisional conflict, screening discussion, and screening choice. Results: Of 19 eligible trials (12781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). Conclusions and Relevance: The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.

Original languageEnglish (US)
JournalJAMA internal medicine
DOIs
StatePublished - Jan 1 2019

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Decision Support Techniques
Early Detection of Cancer
Meta-Analysis
Prostatic Neoplasms
Physicians
Decision Making
Odds Ratio
Outcome Assessment (Health Care)
Information Storage and Retrieval
Patient Education
Exercise Test
MEDLINE
Guidelines
Conflict (Psychology)

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Riikonen, J. M., Guyatt, G. H., Kilpeläinen, T. P., Craigie, S., Agarwal, A., Agoritsas, T., ... Tikkinen, K. A. O. (2019). Decision Aids for Prostate Cancer Screening Choice: A Systematic Review and Meta-analysis. JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2019.0763

Decision Aids for Prostate Cancer Screening Choice : A Systematic Review and Meta-analysis. / Riikonen, Jarno M.; Guyatt, Gordon H.; Kilpeläinen, Tuomas P.; Craigie, Samantha; Agarwal, Arnav; Agoritsas, Thomas; Couban, Rachel; Dahm, Philipp; Järvinen, Petrus; Montori, Victor Manuel; Power, Nicholas; Richard, Patrick O.; Rutanen, Jarno; Santti, Henrikki; Tailly, Thomas; Violette, Philippe D.; Zhou, Qi; Tikkinen, Kari A.O.

In: JAMA internal medicine, 01.01.2019.

Research output: Contribution to journalReview article

Riikonen, JM, Guyatt, GH, Kilpeläinen, TP, Craigie, S, Agarwal, A, Agoritsas, T, Couban, R, Dahm, P, Järvinen, P, Montori, VM, Power, N, Richard, PO, Rutanen, J, Santti, H, Tailly, T, Violette, PD, Zhou, Q & Tikkinen, KAO 2019, 'Decision Aids for Prostate Cancer Screening Choice: A Systematic Review and Meta-analysis', JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2019.0763
Riikonen, Jarno M. ; Guyatt, Gordon H. ; Kilpeläinen, Tuomas P. ; Craigie, Samantha ; Agarwal, Arnav ; Agoritsas, Thomas ; Couban, Rachel ; Dahm, Philipp ; Järvinen, Petrus ; Montori, Victor Manuel ; Power, Nicholas ; Richard, Patrick O. ; Rutanen, Jarno ; Santti, Henrikki ; Tailly, Thomas ; Violette, Philippe D. ; Zhou, Qi ; Tikkinen, Kari A.O. / Decision Aids for Prostate Cancer Screening Choice : A Systematic Review and Meta-analysis. In: JAMA internal medicine. 2019.
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abstract = "Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data Sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study Selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data Extraction and Synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main Outcomes and Measures: Knowledge, decisional conflict, screening discussion, and screening choice. Results: Of 19 eligible trials (12781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95{\%} CI, 1.09-1.73; I2 = 67{\%}; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95{\%} CI, -7.06 to -1.33; I2 = 75{\%}; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95{\%} CI, 0.90-1.39; I2 = 60{\%}; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95{\%} CI, 0.88-1.03; I2 = 36{\%}; low quality). Conclusions and Relevance: The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.",
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T2 - A Systematic Review and Meta-analysis

AU - Riikonen, Jarno M.

AU - Guyatt, Gordon H.

AU - Kilpeläinen, Tuomas P.

AU - Craigie, Samantha

AU - Agarwal, Arnav

AU - Agoritsas, Thomas

AU - Couban, Rachel

AU - Dahm, Philipp

AU - Järvinen, Petrus

AU - Montori, Victor Manuel

AU - Power, Nicholas

AU - Richard, Patrick O.

AU - Rutanen, Jarno

AU - Santti, Henrikki

AU - Tailly, Thomas

AU - Violette, Philippe D.

AU - Zhou, Qi

AU - Tikkinen, Kari A.O.

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N2 - Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data Sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study Selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data Extraction and Synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main Outcomes and Measures: Knowledge, decisional conflict, screening discussion, and screening choice. Results: Of 19 eligible trials (12781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). Conclusions and Relevance: The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.

AB - Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data Sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study Selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data Extraction and Synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main Outcomes and Measures: Knowledge, decisional conflict, screening discussion, and screening choice. Results: Of 19 eligible trials (12781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I2 = 67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I2 = 75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I2 = 60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I2 = 36%; low quality). Conclusions and Relevance: The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter.

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