Are patient decision aids helpful in prostate cancer screening?

  • Riikonen JM & al.
  • JAMA Intern Med
  • 24 Jun 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Patient decision aids on prostate cancer screening are associated with a small reduction in decisional conflict and a small increase in patient knowledge.
  • Decision aids are not associated with screening discussion and actual screening decisions.

Why this matters

  • No formal testing of decision aids is done.

Study design

  • Meta-analysis of 19 eligible trials including 12,781 individuals in whom clinicians used decision aids or usual care for prostate cancer screening for deciding routine prostate cancer screening.
  • Outcomes: patient knowledge regarding prostate cancer screening, decisional conflict, screening discussion, actual screening decision, and decision satisfaction.
  • Funding: Academy of Finland.

Key results

  • Decision aids vs usual care were associated with:
    • small improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73) and
    • small decrease in decisional conflict (mean difference on a 100-point scale, −4.19; 95% CI, −7.06 to −1.33).
  • Decision aids were not associated with:
    • screening discussions between individual and their physicians (risk ratio, 1.12; 95% CI, 0.90-1.39) and
    • actual screening decision (risk ratio, 0.95; 95% CI, 0.88-1.03).
  • 3 studies reported satisfaction with the decision: 2 reported no association and 1 reported greater satisfaction in participants with printed material at 1 month, but no difference in satisfaction at 13 months.

Limitations

  • Low- to moderate-quality evidence.