在前列腺癌查决定之前,共享决策
Kelly R Pekala1, Daniela K Shill2, Mia Austria3
1Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Nature reviews. Urology
|January 3, 2024
概括
共享决策 (SDM) 提高了前列腺癌查知识,但实施情况存在很大差异. 信任促进SDM,而时间限制和低健康素养构成障碍,需要改进临床整合策略.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 前列腺特异性抗原 (PSA) 查决策需要以患者为中心的方法,平衡好处与潜在危害.
- 共享决策 (SDM) 是基于证据的,用于改善患者知识,减少PSA查中的决策冲突.
- 在临床实践中实施SDM存在重大挑战.
研究的目的:
- 确定SDM在前列腺癌查决策中的患病率,使用包容性定义.
- 在此背景下,确定影响SDM实践的促进者和障碍.
主要方法:
- 在PSA查决策中评估SDM的研究的系统审查和元分析.
- 基于包容性SDM定义的流行数据分析.
- 识别报告的促进者和阻碍SDM实施的障碍.
主要成果:
- 在PSA查决策中,SDM的流行率差异很大 (11%-98%),受报告方法的影响 (医生自我报告与患者回忆/观察).
- 医生与患者之间的信任和关系的连续性是SDM的关键促进因素.
- 限定的预约时间和低健康素养被确定为主要障碍.
结论:
- 尽管指导方针得到了认可,但PSA查中的SDM实施不一致.
- 克服时间限制等障碍的策略和提高健康素养对于有效的SDM至关重要.
- 进一步的研究应该集中在增强SDM整合到常规临床护理的实际方法上.
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