Table 3.
Subgroup analysis of the PDSIs on invasive treatment choice and decision-making–related outcomes
| Test of heterogeneity | ||||||
|---|---|---|---|---|---|---|
| Variables | Number of trials (references) | Pooled estimate (95% CI) | I 2 (%) | χ2 | P | χ2, subgroup differences |
| Invasive treatment choice | ||||||
| Types of elective surgery | ||||||
| Breast reconstruction | 376,78,83 | RR=0.99 (0.83, 1.18) | 0.0 | 1.26 | 0.53 | 14.06, P=0.08 |
| Destination therapy LVAD placement | 251,72 | RR=0.77 (0.51, 1.15) | 80.0 | 4.99 | 0.03 | |
| First/repeat cesarean section | 459,73,80,87 | RR=0.99 (0.87, 1.14) | 41.8 | 5.15 | 0.16 | |
| Lumbar spine surgery | 258,82 | RR=0.70 (0.49, 1.01) | 19.9 | 1.25 | 0.26 | |
| Lumpectomy and/or mastectomy | 867,74,77,85,91,101,103,105 | RR=1.13 (0.88, 1.46) | 59.2 | 17.14 | 0.02 | |
| Prophylactic mastectomy/oophorectomy/hysterectomy | 5 69,95,96,102 | RR=1.12 (1.01, 1.24) | 0.0 | 1.53 | 0.82 | |
| Prostatectomy/radical prostatectomy or orchidectomy | 353,75,97 | RR=0.91 (0.65, 1.26) | 86.7 | 15.03 | <0.001 | |
| Total knee/hip/joint replacement/arthroplasty | 655,65,66,84,89,100 | RR=1.01 (0.89, 1.15) | 52.7 | 10.57 | 0.06 | |
| Othersa | 952,61,64,68,90,98,104,106,107 | RR=0.87 (0.73, 1.03) | 53.5 | 17.19 | 0.03 | |
| Mode of delivery | ||||||
| Clinician-delivered | 1151,53,66,67,72,73,90,96,97,101,103 | RR=0.88 (0.73, 1.07) | 79.2 | 48.16 | <0.001 | 1.33, P=0.25 |
| Self-guided | 3152,55,58,59,61,64,65,68,69,74–78,80,82–85,87,89,91,95,98,100,102,104–107 | RR=1.00 (0.93, 1.07) | 52.9 | 63.74 | <0.001 | |
| Consider value | ||||||
| Yes | 2651,59,64–69,73–78,80,83–85,87,89,90,96,97,104,106,107 | RR=0.98 (0.90, 1.07) | 60.6 | 63.39 | <0.001 | 0.27, P=0.61 |
| No | 1652,53,55,58,61,72,82,91,95,98,100–103,105 | RR=0.94 (0.83, 1.07) | 71.1 | 51.95 | <0.001 | |
| Use of theoretical framework | ||||||
| Yes | 1251,59,61,64,67,72,77,78,85,87,98,104 | RR=0.98 (0.83, 1.17) | 61.0 | 28.23 | <0.001 | 0.03, P=0.87 |
| No | 3052,53,55,58,65,66,68,69,73–76,80,82–84,89–91,95–97,100–103,105–107 | RR=0.97 (0.89, 1.05) | 66.6 | 86.73 | <0.001 | |
| PROM-based PDSIs | ||||||
| Yes | 366,90,96 | RR=1.24 (0.85, 1.81) | 0.0 | 1.64 | 0.44 | 1.64, P=0.20 |
| No | 3951–53,55,58,59,61,64–69,72–78,80,82–85,87,89,91,95,97,98,100–107 | RR=0.96 (0.90, 1.04) | 64.5 | 112.09 | <0.001 | |
| Decisional conflict | ||||||
| Types of elective surgery | ||||||
| Breast reconstruction | 576,78,83,86,99 | g=−1.07 (−1.91, −0.23) | 92.1 | 50.63 | <0.001 | 12.80, P=0.03* |
| Destination therapy LVAD placement | 251,72 | g=0.06 (−0.17, 0.29) | 0.0 | 0.69 | 0.41 | |
| First/repeat cesarean section | 273,80 | g=−0.13 (−0.38, 0.12) | 73.3 | 3.75 | 0.05 | |
| Lumpectomy and/or mastectomy | 460,74,101,103 | g=−0.31 (−0.46, −0.15) | 0.0 | 1.33 | 0.72 | |
| Total knee/hip/joint replacement/arthroplasty | 450,57,84 | g=−0.48 (−0.96, 0.01) | 86.6 | 22.31 | <0.001 | |
| Othersb | 1052,54,56,61,64,71,79,98,104,107 | g=−0.16 (−0.29, −0.02) | 53.5 | 19.37 | 0.02 | |
| Mode of delivery | ||||||
| Clinician-delivered | 651,56,72,73,101,103 | g=−0.13 (−0.30, 0.03) | 54.5 | 10.99 | 0.05 | 3.21, P=0.07 |
| Self-guided | 2150,52,54,57,60,61,64,71,74,76,78–80,83,84,86,98,99,104,107 | g=−0.35 (−0.51, −0.18) | 81.8 | 109.78 | <0.001 | |
| Consider value | ||||||
| Yes | 1951,54,56,57,60,64,71,73,74,76,78,80,83,84,86,99,104,107 | g=−0.31 (−0.48, −0.15) | 84.4 | 115.70 | <0.001 | 0.26, P=0.61 |
| No | 850,52,61,72,79,98,101,103 | g=−0.26 (−0.40, −0.12) | 28.1 | 9.73 | 0.20 | |
| Use of theoretical framework | ||||||
| Yes | 1051,54,61,64,72,78,79,86,98,104 | g=−0.29 (−0.54, −0.05) | 81.7 | 49.14 | <0.001 | 0.00, P=1.00 |
| No | 1750,52,56,57,60,71,73,74,76,80,83,84,99,101,103,107 | g=−0.29 (−0.45, −0.14) | 79.8 | 79.13 | <0.001 | |
| PROM-based PDSIs | ||||||
| Yes | 254,57 | g=−0.12 (−0.54, 0.29) | 68.4 | 3.16 | 0.08 | 0.65, P=0.42 |
| No | 2650–52,56,57,60,61,64,71–74,76,78–80,83,84,86,98,99,101,103,104,107 | g=−0.30 (−0.44, −0.17) | 80.6 | 123.68 | <0.001 | |
| Satisfaction with decision-making | ||||||
| Types of elective surgery | ||||||
| Breast reconstruction | 363,78,86 | g=0.09 (−0.16, 0.35) | 31.6 | 2.92 | 0.23 | 0.20, P=1.00 |
| First/repeat cesarean section | 273,80 | g=0.13 (−0.25, 0.51) | 91.6 | 11.86 | <0.001 | |
| Lumpectomy and/or mastectomy | 560,67,77,103,105 | g=0.05 (−0.19, 0.30) | 54.2 | 8.74 | 0.07 | |
| Total knee/hip/joint replacement/arthroplasty | 457,66,84 | g=0.14 (−0.34, 0.61) | 85.8 | 21.12 | <0.001 | |
| Othersc | 470,72,98,104 | g=0.05 (−0.33, 0.43) | 74.1 | 11.56 | 0.01 | |
| Mode of delivery | ||||||
| Clinician-delivered | 666,67,70,72,73,103 | g=0.20 (−0.05, 0.44) | 76.1 | 20.89 | <0.001 | 1.23, P=0.27 |
| Self-guided | 1257,60,63,77,78,80,84,86,98,104,105 | g=0.03 (−0.16, 0.21) | 71.6 | 38.69 | <0.001 | |
| Consider value | ||||||
| Yes | 1357,60,66,67,70,73,77,78,80,84,86,104 | g=0.11 (−0.06, 0.27) | 74.3 | 46.75 | <0.001 | 0.16, P=0.69 |
| No | 563,72,98,103,105 | g=0.04 (−0.25, 0.33) | 69.5 | 13.10 | 0.01 | |
| Use of theoretical framework | ||||||
| Yes | 867,70,72,77,78,86,98,104 | g=0.02 (−0.19, 0.23) | 58.2 | 16.76 | 0.02 | 0.57, P=0.45 |
| No | 1057,60,63,66,73,80,84,103,105 | g=0.13 (−0.06, 0.32) | 79.0 | 42.89 | <0.001 | |
| PROM-based PDSIs | ||||||
| Yes | 257,66 | g=0.23 (−0.61, 1.06) | 89.6 | 9.57 | <0.001 | 0.13, P=0.72 |
| No | 1757,60,63,67,70,72,73,77,78,80,84,86,98,103–105 | g=0.07 (−0.06, 0.21) | 68.8 | 48.03 | <0.001 | |
| Disease and treatment knowledge | ||||||
| Types of elective surgery | ||||||
| First/repeat cesarean section | 273,80 | g=0.28 (−0.28, 0.83) | 95.9 | 21.11 | <0.001 | 3.90, P=0.42 |
| Lumpectomy and/or mastectomy | 460,74,77,105 | g=0.15 (−0.04, 0.34) | 17.2 | 3.62 | 0.31 | |
| Prophylactic mastectomy/oophorectomy/hysterectomy | 279,95 | g=0.20 (−0.16, 0.56) | 72.2 | 3.59 | 0.06 | |
| Total knee/hip/joint replacement/arthroplasty | 350,84,89 | g=0.39 (0.18, 0.61) | 46.8 | 3.76 | 0.15 | |
| Othersd | 452,78,98,106 | g=0.50 (0.06, 0.94) | 85.4 | 20.48 | <0.001 | |
| Mode of delivery | ||||||
| Clinician-delivered | 173 | g=0.00 (−0.11, 0.11) | – | – | – | 12.82, P<0.001** |
| Self-guided | 1450,52,60,74,77–80,84,89,95,98,104,106 | g=0.35 (0.19, 0.51) | 76.0 | 54.13 | <0.001 | |
| Consider value | ||||||
| Yes | 960,73,74,77,78,80,84,89,106 | g=0.39 (0.13, 0.65) | 90.3 | 82.82 | <0.001 | 1.15, P=0.28 |
| No | 650,52,79,95,98,104 | g=0.22 (0.07, 0.38) | 36.7 | 7.89 | 0.16 | |
| Use of theoretical framework | ||||||
| Yes | 477–79,98 | g=0.20 (−0.01, 0.41) | 16.4 | 3.59 | 0.31 | 0.98, P=0.32 |
| No | 1150,52,60,73,74,80,84,89,95,104,106 | g=0.35 (0.14, 0.56) | 88.5 | 86.77 | <0.001 | |
g, Hedges’s g; I 2, percentage of variation across studies that is due to heterogeneity rather than chance; LVAD, left ventricular assist devices; PDSI, patient decision support intervention; PROM, patient-reported outcome measure; RCT, randomized controlled trial; RR, risk ratio.
aBariatric surgery, cataract surgery, aneurysm repair, lung transplantation, surgical termination of pregnancy, shock wave lithotripsy, and retrograde intrarenal surgery.
bBariatric, cataract, general surgery, lung transplantation, percutaneous coronary intervention, prophylactic mastectomy, prostatectomy, shock wave lithotripsy, and retrograde intrarenal surgery.
cLVAD placement, lung transplantation, and general surgery.
dBariatric surgery, lung transplantation, and surgical termination of pregnancy.
*P<0.05.
**P<0.001.