Integrating Shared Decision‐Making Into Breast Cancer Postmastectomy Reconstruction: A Systematic Review of Evidence, Barriers, and Real‐World Implementation

ABSTRACT 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‐consultation educational interventions in supporting shared decision‐making (SDM). Following PRISMA guidelines and a preregistered protocol (OSF: https://osf.io/mu9hv ), six electronic databases and gray literature sources were searched for studies on PMBR DAs through November 2025. Eligible studies were categorized using a five‐domain framework aligned with IPDAS and MRC guidance: (1) DA development and early evaluation, (2) randomized controlled trials (RCTs), (3) qualitative/mixed‐methods studies, (4) implementation and practice‐improvement studies, and (5) pre‐consultation educational interventions. Study quality was assessed using the QualSyst tool. Thirty‐two studies met the inclusion criteria, comprising 16 RCTs, 10 observational designs, and 6 qualitative or mixed‐methods investigations. Across formats (digital, paper‐based, and multimedia), DAs consistently improved patient knowledge (mean increase 15%–30%), reduced decisional conflict (20%–50% reduction), and enhanced values clarification, with high acceptability. Effects on SDM behaviors, consultation dynamics, and long‐term 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‐concordant decision‐making. Despite strong evidence from high‐quality RCTs, further research is needed to optimize implementation, integrate DAs into routine workflows, and tailor interventions to psychosocial and equity‐related patient needs.