Background: Active surveillance is an evidence-based management option for select patients with low-risk thyroid cancer, however identifying appropriate candidates remains challenging for clinicians. Decision support tools may help guide this process.

Aims: This scoping review examines existing decision support tools for active surveillance across a range of low-risk cancers (including prostate, breast and thyroid). Results of this review will be utilised to refine of a pilot tool designed to support clinicians select patients who are appropriate candidates for active surveillance of thyroid cancer. 

Methods: PubMed, MEDLINE, EMBASE and Cochrane were searched from inception to January 2023 (EW), with no date limits. Studies were imported into Covidence; duplicates were removed and abstracts/titles screened for eligibility.

Results: Of 3542 unique studies identified, 3457 were excluded, leaving 85 for full-text screening and 23 for final analysis (19 prostate, 2 breast, 1 thyroid, 1 all-cancer). Fifteen unique decision support tools were identified. Results of studies addressed reatment choice, patient knowledge, decisional conflict, anxiety, decision satisfaction, regret, and tool usability. Compared with controls, decision aid use was associated with increased active surveillance uptake, greater patient knowledge, and reduced decisional conflict. Web-based tools proved feasible for both patients and clinicians, streamlining treatment decision-making. All bar one of the tools examined were designed for patient used, with one tool designed to assist clinicians in the decision making process for active surveillance.

Conclusion: This review maps the key features of decision support tools used in active surveillance of low-risk cancers. There is a trend towards improved patient knowledge, increased uptake or active surveillance and reduced decision conflict when using a decision support aid. This review provides a framework to guide development of a thyroid cancer-specific tool.