Patient decision aids in breast surgery and breast reconstruction reduce decisional conflict: a systematic review and meta-analysis

Abstract

Purpose: Around 310,000 new cases of breast cancer (BC) are diagnosed each year. Complex treatment options often overwhelm patients. Patient decision aids (PDAs) assist in surgical decision-making, but reviews of their quality and efficacy are limited. This study systematically reviews breast surgery (BS) and breast reconstruction (BR) PDAs using the International Patient Decision Aid Standards and Cochrane tools to identify gaps and provide evidence-based recommendations. Methods: A systematic review following PRISMA guidelines examined the impact of PDAs on decision-making for BC patients considering BS and BR. From 1198 articles, 35 met the inclusion criteria. Data on PDA components, study design, and results were extracted, focusing on decisional conflict and anxiety, measured by the Decisional Conflict Scale (DCS) and the State-Trait Anxiety Inventory (STAI). PDA quality and study design were assessed using Cochrane, IPDASi, and ROBINS-I tools. Results: Eight studies evaluated the effect of PDAs on decisional conflict. The pooled mean difference of 3.08 points (95% CI: − 0.62 to 6.79, p = 0.10) favored the PDA group but was not statistically significant. Two studies, however, reported notable reductions in decisional conflict with effect sizes of 13.50 and 12.80 points, respectively. The pooled effect size of PDA exposure on patient anxiety was 1.93 (95% CI: − 0.46 to 4.31) in favor of PDAs, but was not statistically significant (p = 0.11). The evaluation of PDA content quality revealed variable results. Conclusion: BS and BR PDAs were not found to significantly reduce decisional conflict and anxiety in breast cancer patients. Standardized, evidence-based tools are needed.