Background: Shared decision-making (SDM) has been shown to be beneficial to patients and improve health outcomes. While more research is being conducted on the topic of SDM, the incorporation of interventions to facilitate or improve SDM in neuro-oncology has not been widely studied. This study aimed to systematically review the types and impact of SDM interventions used in neuro-oncology. Methods: Systematic searches were conducted in Medline, Embase, Global Health, Cinahl, Web of Science, and Scopus from inception to May 2024. Full-text, peer-reviewed articles were evaluated based on inclusion criteria. Data extracted from articles included the author, year, location, type of intervention, and variable outcomes. Results: The searches resulted in 4674 original articles. Four studies with a total of 172 patients diagnosed with anaplastic oligodendroglioma, anaplastic astrocytoma, high-grade glioma (HGG), low-grade glioma (LGG), glioblastoma, and brain metastases met the inclusion criteria. Types of SDM interventions included SDM training for health care workers, decision grids, three-dimensional (3D) printed models of brain tumors, goals of care videos, and an online tool providing information on disease progression. Overall impact of SDM interventions resulted in improvement in patients’ understanding of their medical condition, treatment options, and satisfaction with the SDM process. Conclusion: SDM can be improved through the use of interventions and aids and can have a positive impact on brain tumor patients. However, there is a significant gap within neuro-oncology literature on SDM interventions. Therefore, to understand how to best improve SDM from the perspective of patients, there is a pressing need for more research on SDM interventions in neuro-oncology.

Glioblastomas are the most common primary malignant brain tumor. Most of the recent improvements their treatment are due to improvements in surgery. Although many would consider surgery as the most personalized treatment, the variation in resection between surgeons suggests there remains a need for objective measures to determine the best surgical treatment for individualizing therapy for glioblastoma. We propose applying a personalized medicine approach to improve outcomes for patients. We suggest looking at personalizing preoperative preparation, improving the resection target by understanding what needs removing and what ca not be removed, and better patient selection with personalized rehabilitation plans for all patients.

Scarce resource allocation in traumatic brain injury (TBI) care is ethically challenging. We surveyed neurosurgeons about their views on surgical decision-making in TBI in resource-limited settings. Neurosurgeons and trainees completed an online survey about surgical decision-making for TBI when neurosurgical capacity is limited. The survey included questions about the impact of patient-level factors (such as the patient's need for surgery or potential for improvement in mortality) and system-level factors (such as operating theater and bed space availability) on decision-making, as well as the perceived fairness of several resource allocation principles when applied to TBI surgery. The 63 respondents were from low- and/or middle-income countries (27%) and high-income countries (73%, n = 46). Most neurosurgeons (61%, n = 35/57) reported the patient's need for surgery as the primary patient-level driver of decision-making, and operating room space was the main system-level factor (71%, n = 35/49). Neurosurgeons generally thought sickest-first and prognosis were the fairest resource allocation principles. Respondents generally prioritized their patients' need for surgery, projected benefits, and system considerations such as operating theater capacity in their decision to operate. Respondents prioritized both the sickest patients and those with the best prognosis in the setting of limited surgical capacity. Future research should explore how to work towards an agreed-upon framework for decision-making in resource-scarce settings in a just and equitable way.