Guixian Tong1,2, Qingqing Geng3, Debin Wang4, Tongzhu Liu5. 1. School of Management, Hefei University of Technology, No.193 Tunxi Road, Hefei, People's Republic of China. 2. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, People's Republic of China. 3. The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Anhui University of Traditional Chinese Medicine, No.177 Meishan Road, Hefei, People's Republic of China. 4. School of Health Service Management, Anhui Medical University, No.81 Meishan Road, Hefei, People's Republic of China. dbwang@vip.sina.com. 5. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No.17 Lujiang Road, Hefei, People's Republic of China. ahslyyltz@163.com.
Abstract
OBJECTIVE: The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types. METHODS: Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg's test, Egger's test, and Cochrane Collaboration's tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2. RESULTS: A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being -0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies. CONCLUSIONS: Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area. PROSPERO REGISTRATION NUMBER: CRD42020218991.
OBJECTIVE: The aim of this study is to evaluate the effectiveness of web-based decision aids (WDAs) on cancer-related clinical care in terms of different decision categories and by different cancer types. METHODS: Literature retrieval utilized highly inclusive algorithms searching randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library and manual searching of eligible studies from reference lists of relevant articles. Two researchers examined the articles selected separately and extracted the information about the studies (e.g., decision category, sample sizes, and outcome indicators) using a data-extracting form and performed risk of bias assessment of the included studies with Begg's test, Egger's test, and Cochrane Collaboration's tool. Meta-analysis of the pooled effects of WDAs on outcome indicators was performed via Review Manager 5.2. RESULTS: A total of 24 RCTs met the inclusion criteria, involving 9846 participants. Overall meta-analysis revealed statistically significant effects on cancer decisional conflict, knowledge, and making informed choice with the overall effect sizes being -0.29 (standardized mean difference, SMD), 0.47 (SMD), and 1.92 (risk ratio, RR) respectively. Subgroup analysis revealed significant effects in indicators including decisional conflict, knowledge, satisfaction, participation in decision-making, and screening behavior, though some extent of heterogeneity and quality flaws existed among the included studies. CONCLUSIONS: Although our research results showed evidence of WDA effects on certain outcome indicators of cancer decisions, these results should be interpreted with caution given the heterogeneity and quality flaws. It is still premature to conclude whether WDA was effective in optimizing cancer clinical decision-making, and more efforts are needed in this area. PROSPERO REGISTRATION NUMBER: CRD42020218991.
Entities:
Keywords:
Cancer; Clinical decisions; Shared decision-making; Web-based decision aids
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