A mixed methods systematic review of cancer treatment decision-making in vulnerable populations
Year: 2026
Type: review
Study design: Systematic Review
Abstract: INTRODUCTION: Vulnerable cancer patients are at risk of making uninformed treatment decisions. Most patient decision aids (PtDAs) have been developed for high-income country (HIC) populations, with limited testing or adaptation for use in vulnerable populations, either contextually or geographically. This review aimed to understand how PtDAs address the treatment decision-making needs of vulnerable cancer patients. METHODS: We conducted a mixed-methods systematic review of RCTs and other effectiveness studies of PtDAs as well as qualitative studies on the treatment decision-making experiences of vulnerable adults (≥18 years) with cancer. Eight databases were searched. Following PRISMA guidelines, we screened for eligible studies and appraised their methodological quality. Qualitative and quantitative findings were synthesized separately and then integrated to identify gaps and alignments between PtDA design and patient-reported decision support needs. RESULTS: Twenty-six studies met the inclusion criteria (14 quantitative, 11 qualitative, and one mixed method). Qualitative synthesis showed that vulnerable patients experienced high emotional and psychosocial burdens, preferred in-person support, and often encountered mismatches between their preferred and actual decision-making roles. The narrative synthesis of quantitative studies showed that most PtDAs improved knowledge (5/7 studies) and reduced decisional conflict (6/7), while their effects on shared decision-making were mixed (3/5). DISCUSSION: PtDAs that provided clear, concise information and were delivered face-to-face better addressed the needs of vulnerable patients than self-administered tools. Although patients reported significant emotional and psychosocial burdens, no PtDAs included structured counselling. PRACTICE IMPLICATIONS: Patient decision aids should be tailored to meet the informational, emotional, and role-support needs of vulnerable cancer patients, particularly in resource-constrained settings.
Source: Patient Education and Counseling
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,830
Awards: Novel predictors of survival among breast cancer patients with/without HIV in South Africa, NORA - Netzwerk für onkologische Forschung in Afrika - Globale Onkologie Martin-Luther-Universität, HIV's Effects on Breast Cancer Treatment and Outcomes in South Africa, G9000177653, Behavioral and Psychosocial Effects on Study Outcomes in End-Stage Cancer Treatment (BEST End-Stage Cancer Study)
OpenAlex ID: W7124435929