Skip to main content

Advertisement

SpringerLink
Log in

Web-based decision aids for cancer clinical decisions: a systematic review and meta-analysis

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types.

Methods

Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg’s test, Egger’s test, and Cochrane Collaboration’s tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2.

Results

A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being –0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies.

Conclusions

Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area.

PROSPERO registration number

CRD42020218991

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Code availability

Not applicable.

References

  1. Woodhouse KD, Tremont K, Vachani A et al (2017) A review of shared decision-making and patient decision aids in radiation oncology. J Cancer Educ 32(2):238–245. https://doi.org/10.1007/s13187-017-1169-8

    Article  PubMed  Google Scholar 

  2. Covvey JR, Kamal KM, Gorse EE et al (2019) Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature. Support Care Cancer. 27(5):1613–1637. https://doi.org/10.1007/s00520-019-04675-7

    Article  PubMed  Google Scholar 

  3. Makridakis S, Kirkham R, Wakefield A et al (2019) Forecasting, uncertainty and risk; perspectives on clinical decision-making in preventive and curative medicine. International Journal of Forecasting 35(2):659–666. https://doi.org/10.1016/j.ijforecast.2017.11.003

    Article  Google Scholar 

  4. Fried TR (2016) Shared decision making-finding the sweet spot. New England Journal of Medicine 374(2):104–106. https://doi.org/10.1056/NEJMp1510020

    Article  Google Scholar 

  5. Tong G, Geng Q, Xu T et al (2021) Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol. BMC Med Inform Decis Mak 21(1):85. https://doi.org/10.1186/s12911-021-01457-2

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dang BN, Westbrook RA, Njue SM et al (2017) Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Medical Education 17(1):32. https://doi.org/10.1186/s12909-017-0868-5

    Article  PubMed  PubMed Central  Google Scholar 

  7. Knops AM, Legemate DA, Goossens A et al (2013) Decision aids for patients facing a surgical treatment decision: a systematic review and meta-analysis. Ann Surg. 257(5):860–866. https://doi.org/10.1097/SLA.0b013e3182864fd6

    Article  PubMed  Google Scholar 

  8. Hargraves I, LeBlanc A, Shah ND et al (2016) Shared decision making: the need for patient-clinician conversation, not just information. Health Affairs 35(4):627–629. https://doi.org/10.1377/hlthaff.2015.1354

    Article  PubMed  Google Scholar 

  9. Stiggelbout AM, Pieterse AH, De Haes JCJM (2015) Shared decision making: concepts, evidence, and practice. Patient Education and Counseling 98(10):1172–1179. https://doi.org/10.1016/j.pec.2015.06.022

    Article  CAS  PubMed  Google Scholar 

  10. McAlpine K, Lewis KB, Trevena LJ et al (2018) What is the effectiveness of patient decision aids for cancer-related decisions? A systematic review subanalysis. JCO Clin Cancer Inform. 2:1–13. https://doi.org/10.1200/CCI.17.00148

    Article  PubMed  Google Scholar 

  11. Stacey D, Légaré F, Lewis K et al (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 4(4):CD001431. https://doi.org/10.1002/14651858.CD001431.pub5

    Article  PubMed  Google Scholar 

  12. Riikonen JM, Guyatt GH, Kilpeläinen TP et al (2019) Decision aids for prostate cancer screening choice: a systematic review and meta-analysis. JAMA Intern Med. 179(8):1072–1082. https://doi.org/10.1001/jamainternmed.2019.0763

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yu L, Li P, Yang S et al (2020) Web-based decision aids to support breast cancer screening decisions: systematic review and meta-analysis. J Comp Eff Res. 9(14):985–1002. https://doi.org/10.2217/cer-2020-0052

    Article  PubMed  Google Scholar 

  14. Baptista S, Teles Sampaio E, Heleno B et al (2018) Web-based versus usual care and other formats of decision aids to support prostate cancer screening decisions: systematic review and meta-analysis. J Med Internet Res. 20(6):e228. https://doi.org/10.2196/jmir.9070

    Article  PubMed  PubMed Central  Google Scholar 

  15. Syrowatka A, Krömker D, Meguerditchian AN et al (2016) Features of computer-based decision aids: systematic review, thematic synthesis, and meta-analyses. J Med Internet Res. 18(1):e20. https://doi.org/10.2196/jmir.4982

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim AH, Girgis A, Karimi N et al (2020) A web-based decision aid (myAID) to enhance quality of life, empowerment, decision making, and disease control for patients with ulcerative colitis: protocol for a cluster randomized controlled trial. JMIR Res Protoc. 9(7):e15994. https://doi.org/10.2196/15994

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stratton E, Choi I, Calvo R et al (2019) Web-based decision aid tool for disclosure of a mental health condition in the workplace: a randomised controlled trial. Occup Environ Med. 76(9):595–602. https://doi.org/10.1136/oemed-2019-105726

    Article  PubMed  Google Scholar 

  18. Roberto A, Colombo C, Candiani G et al (2020) A dynamic web-based decision aid to improve informed choice in organised breast cancer screening. A pragmatic randomised trial in Italy. Br J Cancer. 123(5):714–721. https://doi.org/10.1038/s41416-020-0935-2

    Article  PubMed  PubMed Central  Google Scholar 

  19. Elkin EB, Pocus VH, Mushlin AI et al (2017) Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s. BMC Med Inform Decis Mak. 17(1):29. https://doi.org/10.1186/s12911-017-0423-7

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gabel P, Larsen MB, Edwards A et al (2020) Effectiveness of a decision aid for colorectal cancer screening on components of informed choice according to educational attainment: a randomised controlled trial. PLoS One. 15(11):e0241703. https://doi.org/10.1371/journal.pone.0241703

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Martínez-Alonso M, Carles-Lavila M, Pérez-Lacasta MJ et al (2017) Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis. BMJ Open. 7(10):e016894. https://doi.org/10.1136/bmjopen-2017-016894

    Article  PubMed  PubMed Central  Google Scholar 

  22. Eden KB, Ivlev I, Bensching KL et al (2020) Use of an online breast cancer risk assessment and patient decision aid in primary care practices. J Womens Health (Larchmt). 29(6):763–769. https://doi.org/10.1089/jwh.2019.8143

    Article  PubMed Central  Google Scholar 

  23. Higgins JP, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  24. Frosch DL, Kaplan RM, Felitti VJ (2003) A randomized controlled trial comparing internet and video to facilitate patient education for men considering the prostate specific antigen test. J Gen Intern Med. 18(10):781–787. https://doi.org/10.1046/j.1525-1497.2003.20911.x

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ruffin MT 4th, Fetters MD, Jimbo M (2007) Preference-based electronic decision aid to promote colorectal cancer screening: results of a randomized controlled trial. Prev Med. 45(4):267–273. https://doi.org/10.1016/j.ypmed.2007.07.003

    Article  PubMed  Google Scholar 

  26. Krist AH, Woolf SH, Johnson RE et al (2007) Patient education on prostate cancer screening and involvement in decision making. Ann Fam Med. 5(2):112–119. https://doi.org/10.1370/afm.623

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ilic D, Egberts K, McKenzie JE et al (2008) Informing men about prostate cancer screening: a randomized controlled trial of patient education materials. J Gen Intern Med. 23(4):466–471. https://doi.org/10.1007/s11606-007-0466-z

    Article  PubMed  PubMed Central  Google Scholar 

  28. Frosch DL, Bhatnagar V, Tally S et al (2008) Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening. Arch Intern Med. 168(4):363–369. https://doi.org/10.1001/archinternmed.2007.111

    Article  PubMed  Google Scholar 

  29. Ellison GL, Weinrich SP, Lou M et al (2008) A randomized trial comparing web-based decision aids on prostate cancer knowledge for African-American men. J Natl Med Assoc. 100(10):1139–1145. https://doi.org/10.1016/s0027-9684(15)31481-4

    Article  PubMed  Google Scholar 

  30. Allen JD, Othus MK, Hart A Jr et al (2010) A randomized trial of a computer-tailored decision aid to improve prostate cancer screening decisions: results from the Take the Wheel trial. Cancer Epidemiol Biomarkers Prev. 19(9):2172–2186. https://doi.org/10.1158/1055-9965.EPI-09-0410

    Article  PubMed  PubMed Central  Google Scholar 

  31. Evans R, Joseph-Williams N, Edwards A et al (2010) Supporting informed decision making for prostate specific antigen (PSA) testing on the web: an online randomized controlled trial. J Med Internet Res. 12(3):e27. https://doi.org/10.2196/jmir.1305

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mathieu E, Barratt AL, McGeechan K et al (2010) Helping women make choices about mammography screening: an online randomized trial of a decision aid for 40-year-old women. Patient Educ Couns. 81(1):63–72. https://doi.org/10.1016/j.pec.2010.01.001

    Article  PubMed  Google Scholar 

  33. Schroy PC 3rd, Emmons K, Peters E et al (2011) The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial. Med Decis Making. 31(1):93–107. https://doi.org/10.1177/0272989X10369007

    Article  PubMed  Google Scholar 

  34. Miller DP Jr, Spangler JG, Case LD et al (2011) Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population. Am J Prev Med. 40(6):608–615. https://doi.org/10.1016/j.amepre.2011.02.019

    Article  PubMed  PubMed Central  Google Scholar 

  35. Banegas MP, McClure JB, Barlow WE et al (2013) Results from a randomized trial of a web-based, tailored decision aid for women at high risk for breast cancer. Patient Educ Couns. 91(3):364–371. https://doi.org/10.1016/j.pec.2012.12.014

    Article  PubMed  PubMed Central  Google Scholar 

  36. Taylor KL, Williams RM, Davis K et al (2013) Decision making in prostate cancer screening using decision aids vs usual care: a randomized clinical trial. JAMA Intern Med. 173(18):1704–1712. https://doi.org/10.1001/jamainternmed.2013.9253

    Article  PubMed  PubMed Central  Google Scholar 

  37. Watts KJ, Meiser B, Wakefield CE et al (2014) Online prostate cancer screening decision aid for at-risk men: a randomized trial. Health Psychol. 33(9):986–997. https://doi.org/10.1037/a0034405

    Article  PubMed  Google Scholar 

  38. Manne SL, Topham N, D'Agostino TA et al (2016) Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psychooncology. 25(12):1424–1433. https://doi.org/10.1002/pon.3984

    Article  PubMed  Google Scholar 

  39. Reder M, Kolip P (2017) Does a decision aid improve informed choice in mammography screening? Results from a randomised controlled trial. PLoS One. 12(12):e0189148. https://doi.org/10.1371/journal.pone.0189148

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Sherman KA, Kilby CJ, Shaw LK et al (2017) Facilitating decision-making in women undergoing genetic testing for hereditary breast cancer: BRECONDA randomized controlled trial results. Breast. 36:79–85. https://doi.org/10.1016/j.breast.2017.10.001

    Article  PubMed  Google Scholar 

  41. Manne SL, Smith BL, Frederick S et al (2020) B-Sure: a randomized pilot trial of an interactive web-based decision support aid versus usual care in average-risk breast cancer patients considering contralateral prophylactic mastectomy. Transl Behav Med. 10(2):355–363. https://doi.org/10.1093/tbm/iby133

    Article  PubMed  Google Scholar 

  42. Cuypers M, Lamers RED, Kil PJM et al (2018) Impact of a web-based prostate cancer treatment decision aid on patient-reported decision process parameters: results from the Prostate Cancer Patient Centered Care trial. Support Care Cancer. 26(11):3739–3748. https://doi.org/10.1007/s00520-018-4236-8

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ehrbar V, Urech C, Rochlitz C et al (2019) Randomized controlled trial on the effect of an online decision aid for young female cancer patients regarding fertility preservation. Hum Reprod. 34(9):1726–1734. https://doi.org/10.1093/humrep/dez136

    Article  PubMed  Google Scholar 

  44. Politi MC, Lee CN, Philpott-Streiff SE et al (2020) A randomized controlled trial evaluating the BREASTChoice tool for personalized decision support about breast reconstruction after mastectomy. Ann Surg. 271(2):230–237. https://doi.org/10.1097/SLA.0000000000003444

    Article  PubMed  Google Scholar 

  45. Schapira MM, Hubbard RA, Seitz HH et al (2019) The impact of a risk-based breast cancer screening decision aid on initiation of mammography among younger women: report of a randomized trial. MDM Policy Pract. 4(1):2381468318812889. https://doi.org/10.1177/2381468318812889

    Article  PubMed  PubMed Central  Google Scholar 

  46. Smith SK, Westbrook K, MacDermott K et al (2020) Four conversations: a randomized controlled trial of an online, personalized coping and decision aid for metastatic breast cancer patients. J Palliat Med. 23(3):353–358. https://doi.org/10.1089/jpm.2019.0234

    Article  PubMed  Google Scholar 

  47. Gabel P, Edwards A, Kirkegaard P et al (2020) The LEAD trial-the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: a randomised controlled trial. Patient Educ Couns. 103(2):359–368. https://doi.org/10.1016/j.pec.2019.08.029

    Article  PubMed  Google Scholar 

  48. Goldwag J, Marsicovetere P, Scalia P et al (2019) The impact of decision aids in patients with colorectal cancer: a systematic review. BMJ Open. 9(9):e028379. https://doi.org/10.1136/bmjopen-2018-028379

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ivlev I, Hickman EN, McDonagh MS et al (2017) Use of patient decision aids increased younger women’s reluctance to begin screening mammography: a systematic review and meta-analysis. J Gen Intern Med. 32(7):803–812. https://doi.org/10.1007/s11606-017-4027-9

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This paper was co-supported by Fundamental Research Funds for the Central Universities (grant number WK9110000014) and the Key Research and Development Projects in Anhui (grant number 1804b06020377).

Author information

Authors and Affiliations

  1. School of Management, Hefei University of Technology, No.193 Tunxi Road, Hefei, People’s Republic of China

    Guixian Tong

  2. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, People’s Republic of China

    Guixian Tong & Tongzhu Liu

  3. The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, No.177 Meishan Road, Hefei, People’s Republic of China

    Qingqing Geng

  4. School of Health Service Management, Anhui Medical University, No.81 Meishan Road, Hefei, People’s Republic of China

    Debin Wang

Authors
  1. Guixian Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qingqing Geng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Debin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tongzhu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guixian Tong and Qingqing Geng are co-first authors of the article, they contributed equally in designing the review, retrieving and processing the studies, performing statistical analysis, and drafting the manuscript. Tongzhu Liu and Debin Wang conceived, funded, and facilitated the whole study.

Corresponding authors

Correspondence to Debin Wang or Tongzhu Liu.

Ethics declarations

Ethics approval

This review article does not have human participation trials conducted by any of the authors.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Fig S1

(JPG 533 kb)

Table S1

(DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tong, G., Geng, Q., Wang, D. et al. Web-based decision aids for cancer clinical decisions: a systematic review and meta-analysis. Support Care Cancer 29, 6929–6941 (2021). https://doi.org/10.1007/s00520-021-06184-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06184-y

Keywords

Search

Navigation