Patient decision support interventions for candidates considering elective surgeries: a systematic review and meta-analysis

Journal article

Background

The increase in elective surgeries and varied postoperative patient outcomes has boosted the use of patient decision support interventions (PDSIs). However, evidence on the effectiveness of PDSIs are not updated. This systematic review aims to summarize the effects of PDSIs for surgical candidates considering elective surgeries and to identify their moderators with an emphasis on the type of targeted surgery.

Design

Systematic review and meta-analysis.

Methods

We searched eight electronic databases for randomized controlled trials evaluating PDSIs among elective surgical candidates. We documented the effects on invasive treatment choice, decision-making-related outcomes, patient-reported outcomes, and healthcare resource use. The Cochrane Risk of Bias Tool version 2 and Grading of Recommendations, Assessment, Development, and Evaluations were adopted to rate the risk of bias of individual trials and certainty of evidence, respectively. STATA 16 software was used to conduct the meta-analysis.

Results

Fifty-eight trials comprising 14 981 adults from 11 countries were included. Overall, PDSIs had no effect on invasive treatment choice (risk ratio=0.97; 95% CI: 0.90, 1.04), consultation time (mean difference=0.04 min; 95% CI: -0.17, 0.24), or patient-reported outcomes, but had a beneficial effect on decisional conflict (Hedges' g =-0.29; 95% CI: -0.41, -0.16), disease and treatment knowledge (Hedges' g =0.32; 95% CI: 0.15, 0.49), decision-making preparedness (Hedges' g =0.22; 95% CI: 0.09, 0.34), and decision quality (risk ratio=1.98; 95% CI: 1.15, 3.39). Treatment choice varied with surgery type and self-guided PDSIs had a greater effect on disease and treatment knowledge enhancement than clinician-delivered PDSIs.

Conclusions

This review has demonstrated that PDSIs targeting individuals considering elective surgeries had benefited their decision-making by reducing decisional conflict and increasing disease and treatment knowledge, decision-making preparedness, and decision quality. These findings may be used to guide the development and evaluation of new PDSIs for elective surgical care.

Authors: Cheng, LJ; Bansback, N; Liao, M; Wu, VX; Wang, W

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Ovid Technologies (Wolters Kluwer Health)
• Journal: International journal of surgery (London, England)
• Volume: 109
• Issue: 5
• Pages: 1382-1399
• Publication date: 2023-04-07
• DOI: 10.1097/js9.0000000000000302
• EISSN: 1743-9159
• ISSN: 1743-9191
• Language: English
• Keywords: Meta-analysis; Health care; Medicine; Elective surgery; MEDLINE; Grading (engineering); Systematic review; Nursing; Physical therapy; Psychological intervention; Randomized controlled trial; Intensive care medicine; Surgery; Internal medicine