手术知情同意:对面医生决策支持工具的全面审查
Alexa D Melucci1, Mariah R Erlick2, Anthony Loria1
1From the Department of Surgery, University of Rochester Medical Center, Rochester, NY.
概括
为共享决策 (SDM) 提供医生决策支持工具往往缺乏全面的以患者为中心的领域. 未来的工具应该优先考虑沟通,老年人和各种设置,以改善外科同意.
科学领域:
- 医疗信息学 医疗信息学
- 手术决策 - 手术决策
- 医疗保健服务研究 医疗服务研究
背景情况:
- 面向医生的决策支持工具对于在知情同意期间的共享决策 (SDM) 至关重要.
- 这些工具在测量以患者为中心的领域中的全面性仍然不清楚.
- 了解当前工具的局限性对于开发更有效的SDM辅助工具至关重要.
研究的目的:
- 识别SDM中使用的面向医生的工具.
- 评估这些工具测量的以患者为中心的领域.
- 评估老年人和各种临床环境 (可选与紧急) 中的工具可用性.
- 描述未来工具开发的领域.
主要方法:
- 使用Embase,Medline和Web of Science进行范围审查 (2000年1月 - 2022年9月).
- 遵守系统性审查和元分析的优先报告项目,扩展范围审查 (PRISMA-ScR) 准则.
- 标题/摘要审查,然后由两个独立审稿人进行数据抽象.
主要成果:
- 在4365个已识别的产品中,有160个产品符合条件.
- 工具主要集中在可选手术 (79%) 和门诊 (71%) 上.
- 很少有工具适用于老年人 (5%) 或非选择性程序 (9%).
- 预后是最常测量的领域 (85%),而患者的目标 (36%) 和期望 (46%) 不太常见.
- 大多数工具只衡量一个领域;只有6.7%的工具涵盖所有四个领域.
结论:
- 当前的外科SDM工具强调诊断,而不是以患者为中心的领域,如目标和期望.
- 需要采用包含长期预后,患者目标和期望的工具.
- 未来的研究应该优先考虑沟通工具,老年患者的需求,以及在各种临床环境中的适用性.
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