Table 2.
Effectiveness of PDSIs on invasive treatment choice, decision-making–related outcomes, PROs, and outcomes related to healthcare resource use
| Overall effect | Test of heterogeneity | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Outcomes | Number of trials (references) | Sample size | Effect estimate (95% CI) | Z | P | I 2 (%) | χ2 | P | Certainty of evidence |
| Invasive treatment choice | |||||||||
| Postintervention | 4251–53,55,58,59,61,64–69,72–78,80,82–85,87,89–91,95–98,100–107 | 9938 | RR=0.97 (0.90, 1.04) | −0.83 | 0.41 | 64.5 | 115.35 | <0.001 | Very low |
| Follow-up (1–85 months) | 651,72,84,92,100,102 | 1429 | RR=1.05 (0.85, 1.30) | 0.46 | 0.65 | 82.2 | 28.15 | <0.001 | Very low |
| Decision-making–related | |||||||||
| Decisional conflict | |||||||||
| Postintervention | 2750–52,54,56,57,60,61,64,71–74,76,78–80,83,84,86,98,99,101,103,104,107 | 5726 | g=−0.29 (−0.41, −0.16) | −4.41 | <0.001** | 79.7 | 128.27 | <0.001 | Very low |
| Follow-up (1–6 months) | 650,51,79,84,86,103 | 1100 | g=−0.11 (−0.23, 0.01) | −1.84 | 0.07 | 0.0 | 2.70 | 0.75 | Low |
| Subscale of Decisional Conflict Scale | |||||||||
| Informed subscale | 1356,57,60,64,71–73,78,80,84,101,106 | 3215 | g=−0.38 (−0.61, −0.14) | −3.11 | <0.001** | 88.9 | 107.84 | <0.001 | Very low |
| Values clarity subscale | 1256,57,60,64,71–73,78,80,84,101 | 2973 | g=−0.25 (−0.41, −0.08) | −2.89 | <0.001** | 74.8 | 43.69 | <0.001 | Very low |
| Support subscale | 1256,57,60,64,71–73,78,80,84,101 | 2903 | g=−0.17 (−0.29, −0.04) | −2.65 | 0.01* | 50.7 | 22.30 | 0.02 | Very low |
| Uncertainty subscale | 1356,57,60,64,71–73,78,80,84,101,106 | 3218 | g=−0.10 (−0.17, −0.02) | −2.52 | 0.01* | 5.6 | 12.71 | 0.39 | Low |
| Effective decision subscale | 1356,57,60,64,71–73,78,80,84,101,106 | 3212 | g=−0.14 (−0.23, −0.04) | −2.80 | 0.01* | 28.6 | 16.80 | 0.16 | Very low |
| Satisfaction with decision-making | |||||||||
| Postintervention | 1857,60,63,66,67,70,72,73,77,78,80,84,86,98,103–105 | 3744 | g=0.09 (−0.05, 0.22) | 1.26 | 0.21 | 71.7 | 60.0 | <0.001 | Very low |
| Follow-up (6 months) | 484,86,103,104 | 649 | g=0.16 (0.01, 0.32) | 2.09 | 0.04* | 0.0 | 1.55 | 0.67 | Moderate |
| Disease and treatment knowledge | |||||||||
| Postintervention | 1550,52,60,73,74,77–80,84,89,95,98,104,106 | 4118 | g=0.32 (0.15, 0.49) | 3.65 | <0.001** | 84.6 | 90.98 | <0.001 | Very low |
| Follow-up (1–6 months) | 450,52,79,84 | 586 | g=0.10 (−0.06, 0.27) | 1.27 | 0.20 | 0.0 | 0.32 | 0.96 | Moderate |
| Decisional regret | |||||||||
| Postsurgery (immediately–6 months) | 851,70,72,74,76,84,86,104 | 1043 | g=−0.20 (−0.53, 0.13) | −1.21 | 0.23 | 83.6 | 42.68 | <0.001 | Very low |
| Follow-up (4–6 months) | 351,74,104 | 551 | g=0.03 (−0.36, 0.42) | 0.14 | 0.89 | 80.2 | 10.10 | 0.01 | Low |
| Decision quality | |||||||||
| Postintervention | 362,66,83 | 745 | g=0.53 (−0.02, 1.09) | 1.88 | 0.06 | 90.5 | 20.95 | <0.001 | Very low |
| Values-concordance | 462,66,89,107 | 1712 | RR=1.98 (1.15, 3.39) | 2.48 | 0.01* | 90.2 | 30.68 | <0.001 | Very low |
| Preparedness for decision-making | 550,62,72,77,98 | 953 | g=0.22 (0.09, 0.34) | 3.36 | <0.001** | 0.0 | 3.27 | 0.51 | Low |
| Shared decision-making | 366,72,73 | 1527 | g=0.22 (−0.31, 0.75) | 0.80 | 0.42 | 88.7 | 17.76 | <0.001 | Very low |
| Decision self-efficacy | 352,73,105 | 1595 | g=0.02 (−0.07, 0.12) | 0.48 | 0.63 | 0.0 | 0.32 | 0.85 | Moderate |
| Outcome expectations | 352,74,98 | 526 | g=0.11 (−0.57, 0.80) | 0.32 | 0.75 | 93.5 | 30.55 | <0.001 | Very low |
| PROs | |||||||||
| General HRQoL | |||||||||
| Postintervention | 551,71,72,95,96 | 862 | g=0.02 (−0.20, 0.25) | 0.21 | 0.84 | 58.3 | 9.59 | 0.05 | Very low |
| Follow-up (3–9 months) | 351,71,96 | 461 | g=0.13 (−0.18, 0.44) | 0.84 | 0.40 | 61.3 | 5.17 | 0.08 | Low |
| Physical health | 270,71 | 285 | g=0.15 (−0.08, 0.38) | 1.30 | 0.20 | 0.0 | 0.05 | 0.82 | Moderate |
| Mental health | |||||||||
| Postintervention | 271,74 | 363 | g=0.14 (−0.34, 0.62) | 0.59 | 0.57 | 80.3 | 5.08 | 0.02 | Low |
| Follow-up (postoperative–4 months) | 271,74 | 363 | g=0.07 (−0.13. 0.28) | 0.69 | 0.49 | 0.0 | 0.04 | 0.84 | High |
| Condition-specific HRQoL | 566,76,83,99,104 | 379 | g=0.28 (−0.11, 0.67) | 1.39 | 0.17 | 67.8 | 12.4 | 0.01 | Very low |
| Anxiety | |||||||||
| Postintervention | 974,78,80,95,96,99,103,105,106 | 1640 | g=−0.03 (−0.20, 0.13) | −0.40 | 0.69 | 57.9 | 19.0 | 0.01 | Very low |
| Follow-up (4–9 months) | 374,96,103 | 513 | g=−0.05 (−0.25, 0.16) | −0.44 | 0.66 | 27.5 | 2.76 | 0.25 | Moderate |
| Depression | |||||||||
| Postintervention | 651,74,95,96,103,104 | 1191 | g=0.04 (−0.10, 0.17) | 0.51 | 0.61 | 24.7 | 6.64 | 0.25 | Moderate |
| Follow-up (4–9 months) | 451,74,96,103 | 749 | g=−0.02 (−0.19, 0.14) | −0.27 | 0.78 | 24.0 | 3.95 | 0.27 | High |
| Perceived stress | 351,79,95 | 729 | g=−0.00 (−0.19, 0.19) | −0.00 | 1.00 | 40.6 | 3.37 | 0.19 | High |
| Healthcare resources use | |||||||||
| Consultation time (min) | 466,83,99,104 | 362 | MD=0.04 (−0.17, 0.24) | 0.37 | 0.71 | 0.0 | 1.42 | 0.70 | Moderate |
g, Hedges’s g; HRQoL, health-related quality of life; I 2, percentage of variation across studies that is due to heterogeneity rather than chance; MD, mean difference; PDSI, patient decision support intervention; PRO, patient-reported outcomes; RR, risk ratio; Z, overall effect size (Z-statistics); χ2, Cochran’s Q test.
*
P<0.05.
**
P<0.001.