Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review

Area of Science:

• Oncology
• Medical Informatics
• Health Services Research

Background:

• Therapeutic decision-making in oncology is complex, involving multiple data sources and communication challenges.
• Physicians face difficulties in clearly communicating complex decisions to patients for informed consent.
• Computer-based decision tools offer potential support for the oncology decision-making process.

Purpose of the Study:

• To systematically review the adoption and impact of computer-based decision tools in oncology consultations.
• To assess the effectiveness of these tools in improving patient-physician joint therapeutic decision-making.

Main Methods:

• A comprehensive systematic literature search was conducted across multiple databases (Cochrane, MEDLINE, Embase, Web of Science, Scopus, PubMed) from inception to February 2021.
• The search utilized PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines.
• A snowball approach and supplementary searches identified additional relevant studies for quality assessment and data extraction.

Main Results:

• Only 10 out of 4431 unique articles met the selection criteria, identifying 8 distinct computer-based decision tools.
• While communication and information sharing between physicians and patients improved, physicians' adoption of these tools was limited.
• The use of these tools added an average of 5 minutes to consultations, and some physicians reported increased patient anxiety.

Conclusions:

• 60% of the reviewed studies showed positive outcomes, 10% negative, and 30% neutral regarding computer-based decision tool use.
• Low adoption rates persist, hindered by factors such as lack of integration with electronic health records.
• Future tools require enhanced integration and consideration of higher-level factors like health policies and administrative influences for successful implementation.