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Meta-Analysis
. 2023 Mar 14:25:e37953.
doi: 10.2196/37953.

Effectiveness of Interactive Digital Decision Aids in Prenatal Screening Decision-making: Systematic Review and Meta-analysis

Hong Yat Conrad Wong  1   2 , Saba Asim  1 , Qi Feng  3 , Sherry Xiao-Hong Fu  1 , Daljit Singh Sahota  4 , Po Lam So  5 , Dong Dong  1   6
Affiliations
Meta-Analysis

Effectiveness of Interactive Digital Decision Aids in Prenatal Screening Decision-making: Systematic Review and Meta-analysis

Hong Yat Conrad Wong et al. J Med Internet Res. .

Abstract

Background: Increasing prenatal screening options and limited consultation time have made it difficult for pregnant women to participate in shared decision-making. Interactive digital decision aids (IDDAs) could integrate interactive technology into health care to a facilitate higher-quality decision-making process.

Objective: The objective of this study was to assess the effectiveness of IDDAs on pregnant women's decision-making regarding prenatal screening.

Methods: We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists of included studies until August 2021. We included the randomized controlled trials (RCTs) that compared the use of IDDAs (fulfilling basic criteria of International Patient Decision Aid Standards Collaboration and these were interactive and digital) as an adjunct to standard care with standard care alone and involved pregnant women themselves in prenatal screening decision-making. Data on primary outcomes, that is, knowledge and decisional conflict, and secondary outcomes were extracted, and meta-analyses were conducted based on standardized mean differences (SMDs). Subgroup analysis based on knowledge was performed. The Cochrane risk-of-bias tool was used for risk-of-bias assessment.

Results: Eight RCTs were identified from 10,283 references, of which 7 were included in quantitative synthesis. Analyses showed that IDDAs increased knowledge (SMD 0.58, 95% CI 0.26-0.90) and decreased decisional conflict (SMD -0.15, 95% CI -0.25 to -0.05). Substantial heterogeneity in knowledge was identified, which could not be completely resolved through subgroup analysis.

Conclusions: IDDAs can improve certain aspects of decision-making in prenatal screening among pregnant women, but the results require cautious interpretation.

Keywords: informed decision-making; interactive digital decision aids; pregnancy; prenatal screening; systematic review.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of study selection process in the systematic review.
Figure 2
Figure 2
Forest plots for the outcomes knowledge, decisional conflict, the correct estimates of procedure-related miscarriage risk, and the correct estimates of Down syndrome risk. IDDA: interactive digital decision aid.
Figure 3
Figure 3
Subgroup analysis for knowledge. IDDA: interactive digital decision aid.
See this image and copyright information in PMC

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