Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening

SIMPLE SUMMARY: This research was carried out to understand how shared decision-making tools, which facilitate patients and clinicians make decisions based on their values and preferences, can improve decision-making outcomes in cancer screening. The researchers further aimed to explore the preferences of patients and clinicians in terms of the tool’s content, format, and delivery strategies. The review findings showed that SDM tools for cancer screening were more helpful for people facing difficulties in understanding health information or belonging to socially disadvantaged groups, compared to those who have higher educational and socio-economic status and health/language literacy. Moreover, insights from the qualitative synthesis showed that SDM tool preferences for vulnerable populations differ with those of clinicians who are constrained by time during patient consultations. To improve SDM tools, patients and clinicians should collaborate and communicate more. By doing so, they can identify effective delivery strategies that address the needs and preferences of both parties. ABSTRACT: This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians’ and vulnerable populations’ preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients’ values. Considering the complexities of patients’ and clinicians’ preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.