Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis
BackgroundThe online nature of decision aids (DAs) and related e-tools supporting women’s decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. ObjectiveThis syst...
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JMIR Publications
2025-01-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2025/1/e65974 |
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| author | Patricia Villain Laura Downham Alice Le Bonniec Charlotte Bauquier Olena Mandrik Tom Nadarzynski Lorie Donelle Raúl Murillo Eleni L Tolma Sonali Johnson Patricia Soler-Michel Robert Smith |
| author_facet | Patricia Villain Laura Downham Alice Le Bonniec Charlotte Bauquier Olena Mandrik Tom Nadarzynski Lorie Donelle Raúl Murillo Eleni L Tolma Sonali Johnson Patricia Soler-Michel Robert Smith |
| author_sort | Patricia Villain |
| collection | DOAJ |
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BackgroundThe online nature of decision aids (DAs) and related e-tools supporting women’s decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs.
ObjectiveThis systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy.
MethodsWe followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women’s participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results.
ResultsIn total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women’s decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women’s long-term participation in BCS (risk ratio 1.14, 95% CI 1.07-1.23, P<.001, I2=0%). Tailored-to-breast-cancer-risk e-tools increased women’s level of worry (mean difference 0.31, 95% CI 0.13-0.48, P<.001, I2=0%). E-tools also improved women’s adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants (χ21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95% CI 1.43-2.48, P<.001, I2=0%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95% CI 1.09-2.33, P=.02, I2=91%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95% CI 0.65-0.91, P=.002, I2=0%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools.
ConclusionsFeatures-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women’s participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an “on-demand” layered approach to their design. |
| format | Article |
| id | doaj-art-8b326534481e4573b50480da43f0284f |
| institution | Kabale University |
| issn | 1438-8871 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj-art-8b326534481e4573b50480da43f0284f2025-01-29T20:31:17ZengJMIR PublicationsJournal of Medical Internet Research1438-88712025-01-0127e6597410.2196/65974Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-AnalysisPatricia Villainhttps://orcid.org/0000-0002-5060-4668Laura Downhamhttps://orcid.org/0009-0001-1669-6298Alice Le Bonniechttps://orcid.org/0000-0001-9916-8038Charlotte Bauquierhttps://orcid.org/0000-0002-6021-310XOlena Mandrikhttps://orcid.org/0000-0003-3755-3031Tom Nadarzynskihttps://orcid.org/0000-0001-7010-5308Lorie Donellehttps://orcid.org/0000-0001-9276-8639Raúl Murillohttps://orcid.org/0000-0001-7187-9946Eleni L Tolmahttps://orcid.org/0000-0002-7317-0559Sonali Johnsonhttps://orcid.org/0000-0001-8673-9540Patricia Soler-Michelhttps://orcid.org/0000-0002-9278-5962Robert Smithhttps://orcid.org/0000-0003-3344-2238 BackgroundThe online nature of decision aids (DAs) and related e-tools supporting women’s decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. ObjectiveThis systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy. MethodsWe followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women’s participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results. ResultsIn total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women’s decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women’s long-term participation in BCS (risk ratio 1.14, 95% CI 1.07-1.23, P<.001, I2=0%). Tailored-to-breast-cancer-risk e-tools increased women’s level of worry (mean difference 0.31, 95% CI 0.13-0.48, P<.001, I2=0%). E-tools also improved women’s adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants (χ21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95% CI 1.43-2.48, P<.001, I2=0%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95% CI 1.09-2.33, P=.02, I2=91%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95% CI 0.65-0.91, P=.002, I2=0%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools. ConclusionsFeatures-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women’s participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an “on-demand” layered approach to their design.https://www.jmir.org/2025/1/e65974 |
| spellingShingle | Patricia Villain Laura Downham Alice Le Bonniec Charlotte Bauquier Olena Mandrik Tom Nadarzynski Lorie Donelle Raúl Murillo Eleni L Tolma Sonali Johnson Patricia Soler-Michel Robert Smith Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis Journal of Medical Internet Research |
| title | Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis |
| title_full | Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis |
| title_fullStr | Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis |
| title_full_unstemmed | Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis |
| title_short | Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis |
| title_sort | impact of online interactive decision tools on women s decision making regarding breast cancer screening systematic review and meta analysis |
| url | https://www.jmir.org/2025/1/e65974 |
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