Mixed-methods systematic review of shared decision-making tools for cancer screening

Abstract Shared decision-making (SDM) tools hold promise for guiding informed choices in cancer screening. However, their effectiveness among underserved people, as well as the specific characteristics of these tools preferred by this group and clinicians, remains unclear. This review aimed to synthesize evidence on the effectiveness of SDM tools for cancer screening and explored the preferences of underserved 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-analyses showed that SDM tools for cancer screening are effective in reducing decisional conflict for both the general population and the underserved, and in increasing cancer screening knowledge and intention for underserved people only. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes, measured over a six-month period. Insights from the qualitative findings revealed that underserved people highly preferred SDM tools with relevant information about cancer risk, culturally tailored content, and high accessibility, both during clinical encounters and beyond. Meanwhile, clinicians highly preferred tools that can be easily integrated into medical systems, and can effectively guide SDM, while considering their patients’ values and the limited time for consultation. There is strong evidence on the effectiveness of SDM tools in facilitating informed choice in cancer screening, especially among underserved people. However, evidence on long-term outcomes remains insufficient. Additionally, considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential. Key messages • Shared decision-making tools are effective in increasing screening knowledge and intention among underserved people. • Considering the difference in preferences of key stakeholders in terms of tool characteristics, fostering collaboration with them during the creation of an SDM tool for cancer screening is essential.