Impact of Decision Aids for Shared Decision-Making for Patients with Early Stage Breast Cancer: A Systematic Review

To systematically review the evidence on the effectiveness of patient decision aids (PDAs) for women with early stage breast cancer, focusing on decision-making outcomes, psychological variables, and quality of life.

A systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE and SCOPUS databases were searched to identify quantitative, qualitative and mixed-methods studies evaluating PDAs designed to support treatment decision-making in women with early stage breast cancer. Eligible studies included randomized controlled trials, quantitative, qualitative and mixed-methods studies. Outcomes of interest included knowledge, decisional conflict, Shared Decision-Making (SDM), anxiety, depression, and quality of life. Special focus has been given to lower Socio-Economic Status (SES) and lower literacy populations.

Twenty-six studies (5174 participants) met inclusion criteria. PDAs were associated with reduced decisional conflict (6 of 7 studies), improved satisfaction with the decision or decision-making process (4 studies), and enhanced knowledge (4 of 8 studies showing statistically significant improvement). No consistent adverse effects on anxiety or depression were observed. Ten studies focused on lower SES or low-literacy populations, highlighting the effectiveness of pictorial and simplified PDAs in improving knowledge, SDM, and reducing decisional regret. Qualitative findings indicated high acceptability but identified barriers related to timing and institutional implementation.

PDAs for women with early stage breast cancer enhance knowledge and support informed, value-congruent treatment decisions. However, evidence regarding their impact on psychological well-being and long-term quality of life remains inconclusive. Further research should also address institutional implementation policies.