A mixed methods systematic review of cancer treatment decision-making in vulnerable populations.
Charmaine L Blanchard, Patricia McInerney, Maureen Joffe and 3 others
PMID 41570487WHAT IT FOUND
Patient decision aids improved knowledge and reduced decisional conflict for vulnerable cancer patients, but self-administered tools alone were less effective than those integrated into consultations with staff support or visual formats.
Key findings
01Patient decision aids improved knowledge and reduced decisional conflict, but their effectiveness depended on tailoring to literacy needs and integrating support into clinical encounters.
02Tools using pictures or videos and those used during consultations with staff assistance improved knowledge more consistently than text-based, self-administered aids.
03Question prompt lists provided to patients before consultations did not improve shared decision-making, suggesting patient preparation alone is insufficient without changing clinician behaviour.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review was limited to English-language studies, potentially excluding relevant research from non-English-speaking countries. Initial searches for studies in low- and middle-income countries yielded no eligible results, so the scope was expanded to include vulnerable populations in high-income countries, which may not fully capture LMIC-specific barriers. Many included studies lacked clear theoretical frameworks, researcher positionality, or reflexivity, raising the potential for bias. Most randomized controlled trials did not specify blinding of participants, clinicians, or outcome assessors. Quantitative studies varied in intervention delivery and outcomes, complicating direct comparisons and preventing meta-analysis.
Declared interests
One author (CLB) received an honorarium from Mundipharma in 2022. All other authors declared no competing interests.
The easy way to misread this
Do not assume all patient decision aids are equally effective. Self-administered, text-based tools showed limited benefit compared to those integrated into clinical encounters with visual aids or staff support. A question prompt list alone did not improve shared decision-making.