Objective: To evaluate the interactive, currently available, web-based tools to support treatment and surgery decisions in clinical practice and inform the future directions in clinical tool development to support breast cancer care.

Methods: This scoping review was conducted according to the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. It is registered in the International Prospective Register of Systematic Reviews (PROSPERO, ID 272094). We searched PubMed, Embase, PsychInfo, Web of Science, and Scopus to identify articles on the development and validation of web-based clinical decision tools. We extracted and summarized each tool’s name, main purpose, applicable population, intervention discussed, input characteristics, outcomes evaluated, target users, validation status, and the date of the last update. We reviewed each tool's website and tested the content and format of the calculators with pseudo patient characteristics. Additionally, we searched for clinical trials assessing the tools’ effect on user outcomes including shared decision making and patient knowledge. We completed quality assessment using the International Patient Decision Aid Standard instrument (IPDASi).

Results: We identified nine web-based clinical decision tools or prediction calculators. The tools incorporated clinical characteristics (e.g., age) and tumor characteristics (e.g., tumor size, tumor grade, nodal status) as inputs. Personalized outcomes calculated included risk of distant recurrence, overall/breast cancer-related mortality, and survival. Treatment options included endocrine therapy, hormone therapy, chemotherapy, breast conserving surgery, and nipple-sparing mastectomy. Five tools were designed for patient and physician-use, and four were intended for physician-use only. All tools were externally validated, but only one tool was field-tested with patients.

Conclusion: Currently available online interactive decision tools support adjuvant treatment and surgery-related decisions in clinical practice. However, these tools need to be tested for usability, acceptability, feasibility, and facilitation of communication and shared decision-making among patients and their healthcare providers.