Table 1.

Overview of the articles

Authors	Year	Country	Design	Sample	Intervention	Control	Measurement tools	Outcomes	Qualsyst
Lam [11]	2013	China	Randomized control trial	276 patients with early stage BC DA: 138 patients Control: 138 patients	Take-home booklet	The standard information booklet	Treatment decision-making difficulties and decisional conflict scale, knowledge scale, decision regret, Hospital Anxiety and Depression Scale (HADS)-Anxiety subscale and HADS-Depression subscale, decision regret	Choice of surgery did not differ between the DA and control arms. (BCS, MRM or MRM + BR/MRM or MRM + BR) The DA group had lower decisional conflict scores 1 week after consultation (P < 0.016), lower decision regret scores 4 (P < 0.026) and 10 months (P < 0.014) after surgery and lower depression scores 10 months after surgery (P < 0.001)	0.89
Jibaja-Weiss [10]	2011	USA	Randomized control trial	76 patients with early stage BC (I–IIIA) DA: 40 patients Control: 36 patients	An entertainment-based decision aid for breast cancer treatment along with usual care	Usual care only	A questionnaire for evaluating breast cancer knowledge, Satisfaction with Decision Scale (SWD), Satisfaction with the Process of Making a Treatment Decision scale (SWDMP), low-literacy version of the Decisional Conflict Scale	Patients in DA group prefer to MRM (59.5% vs. 39.5%, P = 0.018) than BCS (40.5% vs. 50.0%). (BCS or MRM) DA group showed a significant improvement in knowledge at the pre-surgery assessment (P < 0.001). Both groups showed decreased decisional conflict over the assessment periods (P < 0.001)	0.57
Whelan [15]	2004	Canada	Randomized control trial	201 patients with stage I or II BC and 20 surgeons DA: 94 patients and 10 surgeons Control: 107 patients and 10 surgeons	Decision board (written and visual information) Takes 20 min	Usual consultation style without using the decision board	A 44-item questionnaire for patient knowledge, decisional conflict scale, effective decision-making subscale of the decisional conflict scale, the Spielberger State Anxiety Inventory and the Centre for Epidemiologic Studies Depression scale	Patients in DA group were more likely to choose BCS (94% vs. 76%, P = 0.03). (BCS or MT) The DA group had higher knowledge scores about their treatment options (66.9 vs. 58.7; P < 0.001), had less decisional conflict (1.40 vs. 1.62, P = 0.02), and were more satisfied with decision making (4.50 vs. 4.32, P = 0.05)	0.75
Street [13]	1995	USA	Randomized control trial	60 patients with stage I or II BC DA: 30 patients Control: 30 patients	Multimedia program (including text, graphic display, audio narration, music, and audio–video clips) Takes 30–45 min	An 8-page brochure, Care of Patients with Early Breast Cancer Takes 15–20 min	An 11-item, multiple choice test for knowledge about BC treatment, an 8-item instrument for patients’ optimism, behavioral and self-report measures for patient involvement and physician communication, modified Perceived Involvement in Care Scale (PICS), modified Perceived Decision Control (PDC), 5-item doctor facilitation subscale of PICS	More patients educated with the computer chose BCS (76%) than did those reading the brochure (58%). (BCS or MT) Patients using the computer program scored higher in the knowledge test (mean, 82.6%; SD, 11.58%) after the intervention than did patients reading the brochure (mean, 76.4%; SD, 13.77%). The only variable predicting a patient’s optimism was knowledge (r = 0.31, P < 0.01)	0.61
Wilkins [16]	2006	USA	Nonrandomized trial with concurrent control	101 patients with stage I or II BC DA: 52 patients Control: 49 patients	Educational video Takes 60 min	Written educational materials	Autonomy and Information-Seeking Preferences, Self-Efficacy to Communicate with Physician/Manage Disease, Knowledge about Breast Cancer, State-Trait Anxiety Inventory, Perceived Involvement in Care, Satisfaction with Decision	25% of people who saw the video chose mastectomy compared to 14% of those who did not see the video (P = 0.18; OR = 2.00, 95%CI 0.72–5.53). (BCS or MT) No statistically significant differences between the 2 groups measured with all the scales	0.82
Molenaar [12]	2001	the Netherlands	Nonrandomized trial with concurrent control	180 patients with stage I or II BC DA: 92 patients Control: 88 patients	Interactive Breast Cancer CDROM Takes 70 min	Standard care including oral information and brochures	A 4-item scale for satisfaction with the decision-making process, 3 out of 4 items of the “effective decision-making” subscale of the DCS for satisfaction with the decision, the MOS20 and the EORTC QLQ-BR23	No difference between the CDROM and standard care condition in the treatment decision made. Most patients in both conditions selected BCS (CDROM: 75%; standard care 68%). (BCS or MT) CDROM patients expressed more satisfaction with information, the decision-making process, and communication. CDROM patients reported better physical functioning, less pain and fewer arm symptoms	0.86
Whelan [14]	1999	Canada	Nonrandomized trial with historical control	patients with clinical stage I or II BC and 7 surgeons DA: 175 patients and 7 surgeons Control: 194 patients	The surgical Decision Board Takes 20 min	Before DA	A 6-point Likert scale for patient preference, questionnaire for general acceptability of the decision aid, a 14-statement response for patient comprehension, a 5-point Likert scale for patient satisfaction with information and decision-making	The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% vs. 73%, P = 0.001). (BCS or MT) 98% patients using the Decision Board reported that the Decision Board was easy to understand, and 81% indicated that it helped them make decisions. Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations	0.64

BC breast cancer, DA decision aids, BCS breast-conserving surgery, MRM modified radical mastectomy, BR breast reconstruction, MT mastectomy