Effects of Decision Aids on Decision Knowledge, Conflict, and Satisfaction Among Patients With Cancer: A Systematic Review and Meta-Analysis.

aimTo examine the effects of decision aids (DAs) on decision knowledge, conflict, and satisfaction among patients with cancer.

backgroundDAs are frequently used to improve the quality of health decision-making across various cancer types (e.g., breast, prostate, and colorectal cancer). However, the impact of DAs on decision knowledge, conflict, and satisfaction remains unclear, and the various delivery methods (e.g., telephone, brochure, mixed delivery methods, and web-based delivery methods) exhibit inconsistent effects.

methodsWe systematically searched eight databases and two search engines from inception to November 30, 2025, for randomized controlled trials (RCTs), evaluating DAs in adult cancer patients facing treatment decisions. A frequentist random-effects meta-analysis was conducted using Stata 16.0 to synthesize the primary outcomes of decision knowledge, conflict, and satisfaction. Pooled effects were estimated as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was explored via subgroup and sensitivity analyses. Publication bias was assessed using funnel plots and Egger's test, with the trim-and-fill method applied when indicated. The methodological quality of individual studies was assessed using the Cochrane Risk-of-Bias Tool 2.0 (ROB 2), and the overall certainty of the evidence for each outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

resultsThirty RCTs with 4303 cancer patients were included. The pooled analysis showed a positive effect on decision knowledge (SMD = 0.91, 95% CI: 0.49-1.33) and a reduction in decision conflict (SMD = -0.23, 95% CI: -0.39 to -0.07). No significant effect was observed on decision satisfaction (SMD = 0.03, 95% CI: -0.42-0.48). In subgroup analyses, all three delivery methods (brochure, web-based, and mixed) were associated with increased decision knowledge, while only web-based and mixed methods were associated with reduced decision conflict. DAs designed for both specific and various cancer types were associated with improved knowledge, whereas only those targeting a specific cancer type were associated with reduced conflict.

conclusionDAs are effective in improving decision knowledge and reducing decision conflict, but they do not effectively increase decision satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses should integrate evidence-based DAs, particularly web-based and mixed delivery formats, into routine cancer care to enhance patients' decision knowledge and reduce conflict. To maximize effectiveness, DAs should be tailored based on targeted cancer types, educational levels, and health literacy to achieve unmet needs in decision satisfaction.