{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T19:51:28Z","timestamp":1783453888123,"version":"3.55.0"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    This systematic review synthesizes empirical evidence on the development, effectiveness, patient experience, and implementation of decision aids (DAs) for postmastectomy breast reconstruction (PMBR) and to evaluate the role of pre\u2010consultation educational interventions in supporting shared decision\u2010making (SDM). Following PRISMA guidelines and a preregistered protocol (OSF:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/osf.io\/mu9hv\">https:\/\/osf.io\/mu9hv<\/jats:ext-link>\n                    ), six electronic databases and gray literature sources were searched for studies on PMBR DAs through November 2025. Eligible studies were categorized using a five\u2010domain framework aligned with IPDAS and MRC guidance: (1) DA development and early evaluation, (2) randomized controlled trials (RCTs), (3) qualitative\/mixed\u2010methods studies, (4) implementation and practice\u2010improvement studies, and (5) pre\u2010consultation educational interventions. Study quality was assessed using the QualSyst tool. Thirty\u2010two studies met the inclusion criteria, comprising 16 RCTs, 10 observational designs, and 6 qualitative or mixed\u2010methods investigations. Across formats (digital, paper\u2010based, and multimedia), DAs consistently improved patient knowledge (mean increase 15%\u201330%), reduced decisional conflict (20%\u201350% reduction), and enhanced values clarification, with high acceptability. Effects on SDM behaviors, consultation dynamics, and long\u2010term outcomes were more variable, often constrained by workflow integration challenges and heterogeneity in clinician engagement. Implementation studies demonstrated feasibility and usability but emphasized the need for structured incorporation into clinical encounters. Qualitative findings highlighted persistent informational gaps, expectation misalignment, and psychosocial influences on decision satisfaction. In conclusion, PMBR DAs reliably enhance knowledge, reduce decisional conflict, and support value\u2010concordant decision\u2010making. Despite strong evidence from high\u2010quality RCTs, further research is needed to optimize implementation, integrate DAs into routine workflows, and tailor interventions to psychosocial and equity\u2010related patient needs.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70493","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:57:22Z","timestamp":1778216242000},"page":"1240-1247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Shared Decision\u2010Making Into Breast Cancer Postmastectomy Reconstruction: A Systematic Review of Evidence, Barriers, and Real\u2010World Implementation"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4852-5100","authenticated-orcid":false,"given":"Marta","family":"Maes\u2010Carballo","sequence":"first","affiliation":[{"name":"Department of General Surgery Hospital P\u00fablico de Ver\u00edn  Ourense Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"de\u2010la\u2010Puente\u2010Mota","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Cancer Unit Hospital Lucus Augusti  Lugo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sampol\u2010Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Cancer Unit Hospital Lucus Augusti  Lugo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Mart\u00ednez\u2010Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Cancer Unit Complexo Hospitalario de Ourense  Ourense Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"G\u00f3mez\u2010Fandi\u00f1o","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Cancer Unit Hospital Lucus Augusti  Lugo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.0387"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhqr.2024.01.003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010012\u20102077\u20106"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/07357907.2023.2164895"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38926.629329.AE"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001431.pub6"},{"key":"e_1_2_10_9_1","volume-title":"Evidence\u2010Based Medicine: How to Practice and Teach EBM","author":"Sackett D. 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