Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials

BMC Medical Informatics and Decision Making

Research Article

Kimberly R. Enard¹  Patricia Dolan Mullen²  Robert J. Volk³  Geetanjali R. Kamath³  Nickell M. Dixon⁴ 

[1] Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, USA;Department of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, 7000 Fannin Street, UCT Suite 2522, 77030, Houston, TX, USA;Department of Health Services Research, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1444, Houston, TX, USA;Michigan Department of Health and Human Services, 201 Townsend Street, MI 48913, Lansing, USA;

关键词: Cancer;    Decision aids;    Decision-making;    Disparities;    Social disadvantage;   

DOI  :  10.1186/s12911-016-0303-6

 received in 2016-01-20, accepted in 2016-06-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundShared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations.MethodsWe selected cancer-related US studies from the Cochrane 2014 review of PtDAs and added RCTs meeting Cochrane criteria from searches of PubMed, CINAHL, PsycINFO (January 2010 to December 2013); and reference lists. Two reviewers independently screened titles/abstracts; three reviewers independently screened full text articles, performed data extraction and assessed: 1) inclusion of participants based on seven indicators of social disadvantage (limited education; female gender; uninsured or Medicaid status; non-U.S. nativity; non-White race or Hispanic ethnicity; limited English proficiency; low-literacy), and 2) attention to social disadvantage in the development or evaluation of PtDAs.ResultsTwenty-three of 39 eligible RCTs included participants from at least one disadvantaged subgroup, most frequently racial/ethnic minorities or individuals with limited education and/or low-literacy. Seventeen studies discussed strategies and lessons learned in attending to the needs of disadvantaged social groups in PtDA development; 14 studies targeted disadvantaged groups or addressed subgroup differences in PtDA evaluation.ConclusionsThe diversity of the US population is represented in a majority of cancer-related PtDA RCTs, but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients’ participation in SDM. More detailed attention to the comprehensive range of social factors that determine cancer risk, variations in care and outcomes is needed in the development and evaluation of PtDAs for disadvantaged populations.Trial registrationRegistered 24 October 2014 in PROSPERO International prospective register of systematic reviews (CRD42014014470).

【 授权许可】

CC BY   
© The Author(s). 2016