Communication in decision aids for stage I-III colorectal cancer: A systematic review

Saar Hommes, Ruben Vromans, Felix Clouth, Xander Verbeek, Ignace H J T de Hingh, Emiel Krahmer

Research output: Contribution to journalArticleScientificpeer-review


Objectives: To assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.

Design: Systematic review.

Data sources: DAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.

Eligibility criteria: DAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I-III.

Data extraction and synthesis: After the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.

Results: In total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.

Conclusions: Both instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.
Original languageEnglish
JournalBMJ Open
Publication statusPublished - 28 Apr 2021


  • Colorectal cancer
  • Gastrointestinal Neoplasms
  • Health communication


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