Effectiveness of Decision Aids for Breast Cancer Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND

Decision aids (DAs) have been developed to support decision-making for breast cancer treatments, but evidence regarding their effectiveness remains inconclusive.

OBJECTIVES

To systematically identify and synthesize evidence on the effectiveness of DAs for breast cancer treatment on decision conflict, decision regret, shared decision-making (SDM), quality of life (QoL), health-related quality of life (HRQoL), and surgical choices.

METHODS

A systematic search across 9 databases from inception to October 2025 included randomized and nonrandomized controlled trials in English or Chinese. Methodological quality was assessed using design-specific tools. Certainty of evidence was evaluated using the GRADE approach. Meta-analyses and narrative syntheses were conducted based on data availability.

RESULTS

Forty-eight articles evaluating 46 DAs were included. Pooled analysis suggested that DAs significantly reduce decision conflict (standardized mean difference = -0.70; 95% CI, -0.93 to -0.46) and decision regret (-0.71; -1.03 to -0.40) and improved SDM (0.41; 0.31-0.50) and HRQoL (0.17; 0.05-0.29). However, the effects of DAs on QoL, breast conservation rate, and reconstruction rate remain inconclusive. The study quality varied from low to high risk of bias. The certainty of evidence ranged from very low to moderate, primarily because of substantial heterogeneity.

CONCLUSIONS

This review demonstrates significant benefits of DAs in reducing decision conflict and decision regret and in promoting SDM and HRQoL. However, variability in study quality and low certainty of evidence highlight the need for further rigorous investigations.

IMPLICATIONS FOR PRACTICE: More rigorous trials and economic evaluations are needed to strengthen the evidence base and validate their cost-effectiveness, ensuring sustainable implementation.