Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis

Abstract

Background: Prostate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict.

Objective: This meta-analysis aimed to investigate the impact of using Web-based decision aids to support men's prostate cancer screening decisions in comparison with usual care and other formats of decision aids.

Methods: We searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR).

Results: Of 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD -7.07%; 95% CI -9.44 to -4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD -0.50; 95% CI -0.88 to -0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25).

Conclusions: According to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men.

Keywords: decision aid; decision making; internet; patient participation; prostate; screening.

Figure 1

Study flow diagram. RCT: randomized controlled trial.

Figure 2

Forest plots of standardized mean differences for knowledge. A) Web-based decision aids (DA) versus usual care, B) Web-based decision aids versus printed decision aids, C) Web-based decision versus video decision aids.

Figure 3

Forest plots of mean differences for decisional conflict. A) Web-based decision aids (DA) versus usual care, B) Web-based decision aids versus printed decision aids.

Figure 4

Forest plots of relative risks for participation in decision making. A) Patient controlled or shared decision making: Web-based decision aid (DA) versus usual care, B) Practitioner controlled decision making: Web-based decision aid versus usual care.

Figure 5

Forest plot of relative risks for participation in decision making: Web-based decision aids versus printed decision aids (DA). A) Patient controlled, B) Shared decision making, C) Practitioner controlled.

Figure 6

Forest plot of relative risks for screening behavior - preference for prostate-specific antigen test. A) Web-based decision aids (DA) versus usual care, B) Web-based decision aids versus printed decision aids.