Effect of shared decision-making in patients with breast cancer undergoing breast reconstruction surgery: A systematic review and meta-analysis

Objective

Patients with breast cancer who must undergo breast mastectomy are offered different types of breast reconstruction surgeries. Shared decision-making (SDM) is an important emerging intervention in the decision-making process of patients. This study aimed to evaluate the effects of SDM in patients with breast cancer undergoing breast reconstruction surgery.

Methods

Databases, including China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Database, VIP, PubMed, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Embase, were searched for articles on the application of SDM in patients undergoing breast reconstruction. The literature search retrieval time limit was from inception to February 29, 2024, with Chinese and English language restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used for reporting this work. The randomized controlled trial (RCT) quality was assessed using The Cochrane Collaboration's tool for assessing risk of bias and quasi-randomized trials using Joanna Briggs Institute's critical appraisal tools. The SDM effects on decisional conflict, regret, knowledge, participation, and satisfaction, anxiety, and depression were assessed. Revman5.4 software was used for the meta-analysis.

Results

In total, 18 papers out of 854 records identified from the database search met the eligibility criteria, including 16 articles in English and two articles in Chinese. There were 12 RCTs and six quasi-randomized trials. The meta-analysis results revealed that SDM could reduce decisional conflict [mean difference (MD), −4.49; 95% confidence interval (CI) (−6.70, −2.27); P < 0.001], decisional regret [MD, −6.06; 95% CI (−9.51, −2.61); P < 0.001], and depression [standardized mean difference (SMD), −0.67; 95% CI (−0.99, −0.35); P < 0.001] in patients who underwent breast reconstruction surgery. In addition, SDM can improve decisional participation [SMD, 0.30; 95% CI (0.11, 0.49); P = 0.002] and decisional knowledge [SMD, 0.43; 95% CI (0.11, 0.75); P = 0.009], but with no significant improvement in decisional satisfaction [SMD, 0.30; 95% CI (−0.35, 0.94); P = 0.37] and anxiety [SMD, −0.09; 95% CI (−0.22, 0.04); P = 0.17]. The subgroup analysis of country/region showed that the interventional effect of SDM in Western countries [MD, −3.84; 95% CI (−4.16, −3.52); P < 0.001] was stronger than that in Eastern countries [MD, −1.81; 95% CI (−2.32, −1.30); P < 0.001], and the interventional effect of Booklet group [MD, −6.92; 95% CI (−8.90, −4.94); P < 0.001] was stronger than that of Computer-based group [MD, −3.23; 95% CI (−3.50, −2.96); P < 0.001].

Conclusions

SDM shows positive effects in many aspects in patients with breast reconstruction, including reducing decisional conflict, decisional regret, and depression, whilst improving decisional participation and decisional knowledge. Moreover, SDM seems has better effectiveness in Western countries than that in Eastern countries and the implement of Booklet has better effectiveness than that of Computer-based modality. However, our study shows that SDM has no benefit in terms of decisional satisfaction and anxiety.

Systematic review registration

CRD42024525662.