title: Decision aids for patients facing a surgical treatment decision: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To summarize the evidence available on the effects of decision aids in surgery.
  
  
  BACKGROUND
  When consenting to treatment, few patients adequately understand their treatment options. To help patients make deliberate treatment choices, decision aids provide evidence-based information on the disease, treatment options, and their associated benefits and harms. Although decision aids are not designed to direct patients toward a particular treatment option, it is possible that their introduction will change the proportion of patients that opt for surgery.
  
  
  METHODS
  We searched electronic databases for studies that evaluated a decision aid in patients offered both surgery and alternative treatment options, regarding the effect on the actual treatment choices made. In addition, we documented effects on knowledge, decisional conflict, anxiety, quality of life, patient involvement, satisfaction, mortality, morbidity, and costs.
  
  
  RESULTS
  Seventeen studies were included. Overall, methodological study quality was good. Patients in the decision aid group less often chose to undergo invasive treatment [risk ratio = 0.80; 95% confidence interval, 0.67-0.95), had more knowledge about treatment options [mean difference = 8.99; 95% confidence interval, 3.20-14.78), and experienced less decisional conflict (mean difference = -5.04; 95% confidence interval, -7.10 to -2.99). Levels of anxiety and quality of life were similar.
  
  
  CONCLUSIONS
  Offering a decision aid increases the number of patients who prefer conservative or less invasive treatment options. As decision aids improve patient knowledge and lower decisional conflict without raising anxiety levels, they have a place in surgery to help surgeons and patients achieve well-considered and shared treatment decisions.
authors.affiliation: Department of Surgery, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anouk M
authors.initials: AM
authors.lastname: Knops
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
authors.forename: Astrid
authors.initials: A
authors.lastname: Goossens
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Dirk T
authors.initials: DT
authors.lastname: Ubbink
mesh_terms: D002755:Choice Behavior; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D015233:Models, Statistical; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000523:psychology*