Shared decision-making for supporting women's decisions about breast cancer screening

Area of Science:

• Public Health
• Decision Science
• Oncology

Background:

• Shared decision-making (SDM) is increasingly recommended in clinical guidelines for breast cancer screening decisions.
• SDM involves discussing evidence, values, and preferences to support women's choices about screening participation.
• The overall impact of SDM on women's decisions regarding breast cancer screening remains uncertain.

Purpose of the Study:

• To assess the effect of shared decision-making (SDM) on women's satisfaction, confidence, and knowledge.
• To evaluate SDM's influence on women deciding whether to participate in breast cancer screening programs.

Main Methods:

• A systematic search of multiple databases (Cochrane, MEDLINE, Embase, etc.) was conducted up to August 2023.
• Included parallel and cluster randomized controlled trials (RCTs) involving women aged 40-75 at average/above-average risk.
• Data extraction, risk of bias, and GRADE assessments were performed independently by two review authors.

Main Results:

• Abbreviated SDM forms may enhance knowledge and informed choice, and reduce decisional conflict, but evidence certainty is low to very low.
• Enhanced risk communication without addressing values may increase knowledge (high certainty) but has uncertain effects on informed choice.
• Studies often did not measure key outcomes like satisfaction, and findings varied across different SDM intervention components.

Conclusions:

• Abbreviated SDM and enhanced communication show potential for improving knowledge and reducing decisional conflict in breast cancer screening.
• Uncertainty persists regarding SDM's overall effectiveness in supporting women's screening decisions.
• High-quality RCTs are needed to evaluate SDM in diverse settings, focusing on satisfaction and value-aligned choices.