为那些面临医疗治疗或查决定的人提供决策辅助工具
Dawn Stacey1,2, Krystina B Lewis1, Maureen Smith3
1School of Nursing, University of Ottawa, Ottawa, Canada.
The Cochrane database of systematic reviews
|January 29, 2024
概括
患者决策辅助工具有助于成年人根据他们的价值观做出明智的健康选择. 这些工具可以提高知识和风险感知,而不会增加决策后悔,支持积极参与医疗保健.
科学领域:
- 健康决策的决策过程
- 基于证据的干预措施.
- 患者的参与度 患者的参与度
背景情况:
- 患者决策辅助工具 (PDA) 旨在通过澄清选择,提供基于证据的关于益处和危害的信息,并将选择与个人价值观结合起来,来支持个人做出健康决策.
- 本研究介绍了一份最新的Cochrane评论,首次发表于2003年,最后一次更新于2017年,检查了PDAs的影响.
研究的目的:
- 评估患者决策辅助工具对接受治疗或查决策的成年人的影响.
- 通过综合知识翻译方法来评估影响.
主要方法:
- 从2015年到2022年3月进行了最新的文献搜索,包括随机对照试验,将PDA与通常护理进行比较.
- 提取的数据和对主要结果的偏差风险的评估,包括基于知情的价值观的选择一致性,知识,风险感知准确性,决策冲突和参与.
- 使用随机效应模型进行元分析和GRADE以确保证据评估的确定性.
主要成果:
- 该审查包括209项研究 (107,698名参与者) 在71项决定中,共同领域包括心血管治疗,癌症查/治疗,心理健康和关节置换.
- 中等确定性证据表明,PDAs增加了知情的价值-一致的选择 (RR 1.75). 高确定性证据表明,PDA提高了知识 (MD 11.90/100),风险感知准确性 (RR 1.94),并减少了决策冲突.
- 没有发现决定后悔的显著差异. 在接触期间使用PDA时,咨询时间略有增加.
结论:
- 患者决策辅助器有效地支持成年人在各种决策中做出知情,价值观一致的健康选择.
- PDA显著提高了患者的知识,准确的风险感知和积极的决策参与.
- 虽然PDAs不会增加决策后悔,但需要进一步研究遵守和医疗保健资源利用情况.
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