Shared Decision-Making in Curative Uro-Oncology: A Systematic Review

To synthesize current evidence on shared decision-making (SDM) processes that guide the choice of curative-intent treatment among patients with prostate or bladder cancer.

Following PRISMA 2020 guidelines, we searched seven databases from inception to November 2024 for randomised, observational, and qualitative studies evaluating SDM in treatment selection for localized prostate or bladder cancer. Two reviewers independently screened, extracted data, and appraised quality using the Mixed-Methods Appraisal Tool.

Ten studies (n = 11,506) met inclusion criteria: eight on prostate cancer, one on muscle-invasive bladder cancer, and one mixed cohort. Designs included three randomized controlled trials, five quantitative observational, and two qualitative studies. Structured interventions, decision aids, and joint consultations consistently reduced decisional conflict, improved satisfaction, and sometimes shifted choices toward preference-sensitive options. Nonetheless, reported "involvement" often masked gaps, including limited discussion of long-term side-effects and insufficient clarification of patient preference. Seven studies were rated minimal risk of bias, though many had small samples, restricted blinding, or lacked real-time quality-of-life data. Evidence for bladder cancer was limited to one exploratory study.

Structured SDM interventions and multidisciplinary counselling generally improve decision quality in curative-intended prostate or bladder cancer treatment. Yet, critical elements remain underutilized despite being highly valued by patients. Future work should extend to bladder cancer, incorporate patient-reported outcomes, and test scalable multidisciplinary SDM models to ensure informed, value-concordant care.

Oncology nurses are central to SDM by clarifying patient preferences, addressing side effects, and supporting decision aid use. Their sustained patient relationships foster trust and communication, while nurse-led roles-such as preference elicitation clinics, toxicity prehabilitation counselling, and survivorship navigation-offer structured opportunities to embed SDM. Scripts, checklists, and well-timed consultations can make these approaches consistent and sustainable in everyday practice.