{
  "abstract": "Objectives Patient decision aids (PtDAs) are effective interventions to support patient involvement in health decisions and have the potential to impact favourably on health inequities by reducing gender bias in clinical practice. The aim was to explore sex and gender reporting and differences in randomised controlled trials (RCTs) evaluating PtDAs for adults making treatment or screening decisions.Design Secondary analysis of the Cochrane review of PtDAs of RCTs that reported sex and/or gender. The original review searched MEDLINE, Embase, PsychINFO and EBSCO from journal inception to March 2022. Two team members independently screened citations, extracted data and assessed risk of bias. For this secondary analysis, we only included primary outcomes from the original review. We assessed appropriate use of terminology for sex (biological attribute) and gender (social construct). When terms were used interchangeably, it was considered inaccurate. Findings were synthesised descriptively, and we used meta-analysis when two or more RCTs were conducted with females/women or males/men using similar outcome measures.Primary and secondary outcome measures Informed values-choice congruence and the quality of the decision-making process (eg, knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision making, undecided) and adverse events (eg, decision regret, emotional distress) by sex and gender.Results Of 209 RCTs in the original review, 206 reported sex and/or gender, with 35 (17%) using accurate terminology. Of 206 RCTs, 70 were with females/women only, 27 males/men only, 12 analysed by sex/gender and 97 RCTs did not disaggregate findings by sex or gender. Meta-analysis comparing RCTs for females/women to usual care and RCTs for males/men only compared with usual care showed similar mean differences in knowledge scores (10.84 vs 9.38 out of 100; p=0.44). Males/men had significantly higher self-reported participation in decision making compared with females/women (RR 3.16 vs 0.95; p<0.01). Meta-analysis showed no significant differences in other outcomes.Conclusions In PtDA RCTs, sex and gender terms are used interchangeably and 6% analysed outcomes by sex or gender. Meta-analysis of males/men only given PtDAs showed higher self-reported decision making participation in clinical practice compared to usual care versus females/women only compared with usual care. Researchers must improve reporting sex and gender in PtDA RCTs to assess how it influences health inequities.",
  "authors": [
    {
      "affiliations": [
        "University of Ottawa School of Nursing, Ottawa, Ontario, Canada",
        "Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Dawn Stacey"
    },
    {
      "affiliations": [
        "Department of Family Medicine and Emergency Medicine, Universite Laval, Quebec, Quebec, Canada"
      ],
      "name": "France Légaré"
    },
    {
      "affiliations": [
        "University of Ottawa School of Nursing, Ottawa, Ontario, Canada",
        "University of Ottawa Heart Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Krystina B Lewis"
    },
    {
      "affiliations": [
        "Cochrane Collaboration Consumer Network, Ottawa, Ontario, Canada"
      ],
      "name": "Maureen Smith"
    },
    {
      "affiliations": [
        "Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Meg E Carley"
    },
    {
      "affiliations": [
        "Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Michael J Barry"
    },
    {
      "affiliations": [
        "Methodological and Implementation Research, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Carol Bennett"
    },
    {
      "affiliations": [
        "Instituto Oncológico Fundación Arturo López Pérez, Providencia, Chile",
        "School of Nursing, Universidad Finis Terrae, Santiago, Santiago Metropolitan Region, Chile"
      ],
      "name": "Paulina Bravo"
    },
    {
      "affiliations": [
        "Aalborg University The Faculty of Medicine, Aalborg, North Denmark Region, Denmark"
      ],
      "name": "Karina Dahl Steffensen"
    },
    {
      "affiliations": [
        "Department of Renal Medicine, Aarhus University Hospital, Aarhus, Central Denmark Region, Denmark"
      ],
      "name": "Jeanette Finderup"
    },
    {
      "affiliations": [
        "Department of Nursing, Ariel University School of Health Sciences, Ari’el, Israel"
      ],
      "name": "Yulia Gendler"
    },
    {
      "affiliations": [
        "Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec, Canada"
      ],
      "name": "Amédé Gogovor"
    },
    {
      "affiliations": [
        "Cochrane Collaboration Consumer Network, Glaslyn, Saskatchewan, Canada"
      ],
      "name": "Janet Gunderson"
    },
    {
      "affiliations": [
        "University of Ottawa Heart Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Shannon E Kelly"
    },
    {
      "affiliations": [
        "University of Ottawa School of Rehabilitation Sciences, Ottawa, Ontario, Canada"
      ],
      "name": "Lissa Pacheco-Brousseau"
    },
    {
      "affiliations": [
        "University of Washington, Seattle, Washington, USA"
      ],
      "name": "Logan Trenaman"
    },
    {
      "affiliations": [
        "Sydney University Medical Society, Camperdown, New South Wales, Australia"
      ],
      "name": "Lyndal Trevena"
    },
    {
      "affiliations": [
        "The University of Texas MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Robert J Volk"
    },
    {
      "affiliations": [
        "School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Ian D Graham"
    }
  ],
  "title": "Sex and gender reporting and differences in trials evaluating patient decision aids: a secondary analysis of systematic review with meta-analysis",
  "uid": "686cd561-0d62-5701-b9c4-ab4c7e338651"
}