Journal of cancer survivorship : research and practice · 2026
Effectiveness of decision aids on decisional conflict and treatment or disease knowledge among women diagnosed with breast cancer: a systematic review and meta-analysis.
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Vasan Thakumar Annushiah, Chua Ee Shen, Chern Calvin Wei Jie, Li Xun, Goh Serene Si Ning, Cheng Ling Jie
Аннотация
BACKGROUND: Decision aids are paper-based, digital, or multimedia tools that present treatment options with their benefits and harms and help patients clarify their values alongside clinician counselling. Decisional conflict refers to uncertainty about which treatment option to choose when alternatives involve competing risks, benefits, and personal values. Decision aids support women with breast cancer in making treatment decisions, but evidence on their effectiveness is fragmented and methodologically variable. This systematic review evaluated their effects on decisional conflict, treatment or disease knowledge, and other decision-related outcomes, and examined potential moderators of these effects.
METHODS: We systematically searched seven electronic databases and reported the review in accordance with PRISMA guidelines. The search was updated through 07 February 2026, and no additional trials were identified. We conducted a meta-analysis using a random-effects model with inverse variance weighting. We assessed risk of bias using the Cochrane Risk of Bias tool and evaluated certainty of evidence using GRADE.
RESULTS: We included eighteen studies, of which eleven contributed to the meta-analyses. Decision aids moderately reduced decisional conflict (standardised mean difference - 0.57; 95% CI - 0.95 to - 0.18) and increased treatment or disease knowledge (standardised mean difference 0.56; 95% CI 0.19 to 0.93). Reductions in decisional conflict persisted for up to 4 months, but effects on treatment or disease knowledge at follow-up and on other outcomes were not significant. Heterogeneity was substantial for both primary outcomes, and the certainty of evidence was very low.
CONCLUSION: Decision aids may reduce decisional conflict and increase treatment or disease knowledge among women with breast cancer, although the certainty of evidence is very low. Decision aids may be considered as part of shared decision-making, but adequately powered trials are needed to determine which formats, theoretical frameworks, and delivery modes are most effective.
IMPLICATIONS FOR CANCER SURVIVORS: For women with breast cancer, decision aids may reduce decisional conflict and improve treatment and disease knowledge, supporting informed shared decision-making, though evidence certainty is very low and broader wellbeing outcomes were unaffected.
METHODS: We systematically searched seven electronic databases and reported the review in accordance with PRISMA guidelines. The search was updated through 07 February 2026, and no additional trials were identified. We conducted a meta-analysis using a random-effects model with inverse variance weighting. We assessed risk of bias using the Cochrane Risk of Bias tool and evaluated certainty of evidence using GRADE.
RESULTS: We included eighteen studies, of which eleven contributed to the meta-analyses. Decision aids moderately reduced decisional conflict (standardised mean difference - 0.57; 95% CI - 0.95 to - 0.18) and increased treatment or disease knowledge (standardised mean difference 0.56; 95% CI 0.19 to 0.93). Reductions in decisional conflict persisted for up to 4 months, but effects on treatment or disease knowledge at follow-up and on other outcomes were not significant. Heterogeneity was substantial for both primary outcomes, and the certainty of evidence was very low.
CONCLUSION: Decision aids may reduce decisional conflict and increase treatment or disease knowledge among women with breast cancer, although the certainty of evidence is very low. Decision aids may be considered as part of shared decision-making, but adequately powered trials are needed to determine which formats, theoretical frameworks, and delivery modes are most effective.
IMPLICATIONS FOR CANCER SURVIVORS: For women with breast cancer, decision aids may reduce decisional conflict and improve treatment and disease knowledge, supporting informed shared decision-making, though evidence certainty is very low and broader wellbeing outcomes were unaffected.