Background: Evidence for the role of active surveillance (AS) as an alternative to surgery in the management of low-risk thyroid cancer is well established. Despite this, many clinicians do not feel comfortable in identifying patients who are appropriate for AS.
Aims: This scoping review explores key features that underpin decision support tools or aids looking at AS in prostate, breast and thyroid cancer. This information will be utilised to help refine a pilot clinical decision support tool for low-risk thyroid cancer.
Methods: PubMed, MEDLINE, EMBASE and Cochrane databases were searched. No limits were put on publication date, including studies from inception to January 2023. Studies were imported into Covidence software. Duplicates were removed, then screening of abstracts and titles eliminated further articles.
Results: The search identified 3542 unique studies; 3457 were excluded on review of abstract and title. 85 studies underwentfull text review and 25 studies were included in final analysis. Eight studies were randomised control trials, six were systematic reviews, five were cohort studies, four were qualitative research and two were cross sectional. Twenty one studies addressed prostate cancer, two addressed ductal carcinoma in situ, one addressed thyroid cancer and one looked at all cancers suitable for AS. Themes explored in studies included clinician acceptability of the decision aid, patient knowledge on their cancer, rates of decision conflict and treatment choice. Overall, the use of decision aids reduced decision conflict and demonstrated treatment choice concordant with decision aid recommendations. Web based tools were found to be a feasible tool for both patients and clinicians to streamline the treatment decision process.
Conclusion: This scoping review has identified a framework of the key features of decision aids designed to assist both patient and clinician in approach to treatment of low risk cancers in which active surveillance is a management option.