Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening

Abstract

This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.

Keywords: cancer screening; decision support techniques; patient-centered care; physician–patient relations; shared decision-making; vulnerable populations.

Figure 1

PRISMA flowchart of the study selection process.

Figure 2

Pooled effects of SDM tools for cancer screening on the ‘knowledge’ outcomes for (A) all included participants [45,46,48,52,54,57,58,59,62,68,73,74,75,77,78], (B) vul-nerable people [46,48,52,54,57,58,62,68,74], and (C) non-vulnerable people [45,59,73,75].

Figure 3

Pooled effects of SDM tools for cancer screening on the ‘decision conflict’ outcomes (A) for all included studies [46,52,57,60,62,64,69,70,73,74,75,77,92], (B) for studies with an intervention duration at 6 months or less [46,49,52,60,62,70,77], and (C) above 6 months (between 8 to 13 months follow-up) [57,69,75,92].

Figure 4

Pooled effects of shared decision-making tools for cancer screening on ‘intention to screen’ outcomes for (A) all studies [47,52,57,59,60,61,62,72,76,77,99], (B) vulnerable people [48,52,57,59,60,61,62,76,77,99], and (C) non-vulnerable people [47,52,72,99].

Figure 5

Vulnerable patients and clinicians’ preferences on the specific characteristics of SDM tool. Outer arches: These represent the primary overarching themes that broadly capture the perspectives and experiences of vulnerable individuals and clinicians. Colorful spokes: These symbolize the subthemes, providing detailed descriptions of the main themes. Center bore (circle): This denotes the main outcomes of interest, which are the ‘patient’s preferences’ and ‘clinician’s preferences’ regarding a specific shared decision-making tool. Outer circles: These hold the outer arches and signify the important features that influenced the preferences of patients and clinicians concerning the main themes. For example, if main theme 1 is “format relevance” and main theme 2 is “communication strategies,” the circle in between these themes indicates that format relevance and communication strategies should consider the “accessibility” of the tool.