将共享决策纳入国际心血管指南,2012-2022年
Blair J MacDonald1, Ricky D Turgeon1
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA network open
|September 7, 2023
概括
共享决策 (SDM) 在道德护理中至关重要. 当代的心血管指南提到SDM的重要性,但很少有建议包含它,更少提供工具来促进患者参与.
科学领域:
- 心脏病学 心脏病学
- 医学伦理 医学伦理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 共享决策 (SDM) 对于道德的患者护理至关重要.
- 以前的研究表明,临床指南很少促进SDM.
- SDM在当前心血管指南中的整合尚未得到充分理解.
研究的目的:
- 系统地识别和描述SDM在当代心血管指南中的纳入.
- 通过定义的评级框架来评估SDM集成的质量.
主要方法:
- 一项横截面研究分析了2012-2022年期间发表的ACC,CCS和ESC指南中的药物治疗建议.
- 建议被评为直接性和促进SDM.
- 分析包括指南社会和治疗领域的SDM整合比例.
主要成果:
- 在65条指南中,51%提到SDM. 在2655个药物治疗建议中,只有6% (170) 纳入了SDM.
- 一般心脏病学指南的SDM整合率最高 (10%),心力衰竭的比例最低 (3%).
- 大多数SDM建议 (67%) 提供了最小的便利性 (3D级),只有3%提供了决策辅助 (1A级).
结论:
- 虽然心血管指南承认SDM,但其在药物治疗建议中的实际实施仍然很低.
- 在指导方针中,SDM促进的质量往往不够,缺乏决策辅助或量化风险/收益.
- 需要进一步努力,在心血管临床实践指南中加强SDM整合和支持.
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