Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review

Area of Science:

• Urology
• Oncology
• Health Informatics
• Patient Decision Making

Background:

• Decision aids (DAs) are crucial for shared decision-making in complex uro-oncological treatment choices.
• Evaluating the availability and quality of DAs is essential for enhancing patient-centered care in this field.

Purpose of the Study:

• To systematically assess the quality and characteristics of existing DAs for patients facing treatment decisions for prevalent uro-oncological conditions.
• To identify gaps in DA availability and quality for prostate, renal, and bladder cancers.

Main Methods:

• A systematic literature search adhering to PRISMA guidelines was conducted across multiple databases (MedLine, Cochrane Library, Web of Science, CCMed).
• Studies on the development or evaluation of DAs for prostate, renal, or bladder cancer were included.
• DAs were evaluated using the International Patient Decision Aid Standards (IPDAS), and evaluation studies were assessed against the Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE) checklist.

Main Results:

• Out of 1995 identified publications, 32 studies on 25 DAs met the inclusion criteria.
• The majority of DAs (22) focused on prostate cancer, with fewer for renal (2) and bladder (1) cancers.
• DAs showed high adherence to IPDAS (median 87.5%) and SUNDAE (median 86.6%), with 20 DAs allowing patient data input and 6 offering personalization. Preliminary meta-analysis showed no significant difference in decisional conflict or regret compared to usual care.

Conclusions:

• While numerous well-developed DAs exist in uro-oncology, there's a need for more instruments specifically for kidney and bladder cancers.
• Enhancing personalization features and improving adherence to international DA standards are recommended.
• Existing DAs are of high quality but can be further optimized to meet individual patient needs in uro-oncological treatment decisions.