背景:在癌症治疗中,在临床实践指南(CPG)和共识声明中促进和实施共同决策可能存在性别差异.
目的:系统分析有关CPGs中共同决策的建议,以及针对男性(前列腺)和女性(子宫内膜)中最常见的癌症的共识声明。
方法:我们在PROSPERO(ID:RD42021241127)前瞻性注册了该方案。MEDLINE,EMBASE,WebofScience,Scopus和在线资源(8个指南数据库和65个专业协会网站)由两名审阅者独立搜索,没有语言限制。
方法:2015年1月至2021年8月纳入了关于前列腺癌和子宫内膜癌诊断或治疗的CPGs和共识声明。
方法:质量评估采用了以前开发的31项工具,并分析了两种癌症之间的差异。
结果:共有176份文件符合纳入标准,97用于前列腺癌(84个CPG和13个共识声明),79用于子宫内膜癌(67个CPG和12个共识声明)。与子宫内膜癌相比,前列腺癌指南中建议更频繁地进行共享决策(46/97vs.13/79,47.4%与16.5%;p<.001)。与前列腺癌指南相比(平均2.14项,标准偏差3.45),子宫内膜癌指南对共同决策31项工具的依从性较低(平均0.48项,标准偏差1.29)(p<.001)。关于实施共同决策的建议,仅在3例(3.8%)子宫内膜癌指南和16例(16.5%)前列腺癌指南中报告(p<.001).
结论:我们观察到明显的性别偏见,因为与子宫内膜癌指南相比,在前列腺中更经常系统地推荐共同决策。这些发现应鼓励新的CPG和共识声明考虑共同决策以改善癌症护理,无论受影响的性别如何。
■研究结果可能为专业协会和政府提供未来的建议,以更新和制定高质量的临床指南,以考虑患者的偏好和癌症治疗中的共同决策。
In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and
consensus statements may have potential differences by gender.
To systematically analyse recommendations concerning shared decision-making in CPGs and
consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial).
We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8
guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions.
CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021.
Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed.
A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12
consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer
guidelines (p < .001).
We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected.
The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients\' preferences and shared decision-making in cancer care.