Usefulness of decision aids for cancer screening undecided
Despite strong recommendations from the medical community to use decision aids to foster shared decision-making between clinicians and patients regarding cancer screening, a recent review uncovered a lack of evidence as to whether these tools work.
“There is evidence that decision aids are fairly effective in improving patient knowledge, but we found that they may not be used as well and effectively as they could be,” recounted Masahito Jimbo, MD, PhD, associate professor of family medicine and urology at the University of Michigan Medical School in Ann Arbor, Michigan, in a statement issued by the University of Michigan Health System.
As Jimbo and coauthors explained in CA: A Cancer Journal for Clinicians (2013;63:193-214), recent guidelines have yielded more screening options as well as conflicting recommendations. Patients must decide, with their clinician's help, whether, when, and how to be screened.
The researchers reviewed 79 studies that evaluated the effectiveness of 73 various decision aids, all designed to improve communication between patient and clinician regarding shared decision-making for cancer screening. The decision aids focused on screening for breast, cervical, colorectal, and prostate cancers. Some are self-administered by the patient; others are practitioner-administered.
In the studies reviewed, only half of the decision aids (36) had been evaluated for subsequent screening behavior, and just one-fourth (18) had been assessed for their effect on shared decision-making. Fewer than half (27) of the decision aids employed exercises to clarify the patient's values regarding a given screening test. The review by Jimbo's group uncovered little information on the feasibility and outcomes of integrating decision aids into practice.
Although Jimbo and associates set forth several suggestions for future research regarding how to measure and improve the effectiveness of decision aids, they acknowledge that such instruments are here to stay, and that practical applications are already occurring. With many decision aids now available free of charge, the research team encourages clinicians to explore them, select those that fit best with their current understanding of the topic in question, and apply them to their practice workflow in a creative way.