摘要
目的系统评价心血管领域患者决策辅助工具研发要素及临床应用效果,为推进医患共同决策提供循证依据。方法计算机检索PubMed, Web of Science, CIHNAL, Cochrane Library 数据库,检索时间自建库至2017 年12 月,纳入评价心血管领域患者决策辅助工具的随机对照研究文献。根据纳入标准逐层筛选,并依据Cochrane 偏倚风险评估工具(5.1.0 版)进行文献质量评价,描述患者决策辅助工具研发核心要素,定性评价结局指标干预效果。结果最终纳入13 篇文献,涉及药物治疗、瓣膜置换术、PCI 置入、胸痛检查、心血管恶性疾病预立医嘱等临床决策主题。13 篇文献总体质量中等,其中 3 篇A 级,10 篇B 级。由定性分析可知:(1)现阶段患者决策辅助工具研发主要参照国际患者决策辅助工具标准协作组发布的质量评价标准,工具核心内容包括信息支持、方案利弊分析、患者价值澄清;(2)患者决策辅助工具应用研究中,11 项提高了患者知识水平,3 项提高了风险感知,3 项提高了决策参与度。结论心血管领域患者决策辅助工具通过基于循证的结构化决策支持,实现了最佳临床证据和患者价值取向的统一,有助于提高患者知识水平、风险感知度、决策参与度,是落实共同决策医疗模式的有效手段。
Objective To systematically review the development factors and clinical application of decision aids among cardiovascular disease patients so as to provide an evidence-based basis for pushing shared decision-making of doctor-patient forward. Methods From establishing the database to December 2017, we retrieved and included randomized controlled trials( RCTs) on cardiovascular disease patient decision aids in PubMed, Web of Science, CIHNAL and Cochrane Library by computer. The RCTs were screened based on inclusive criteria and were evaluated with the Cochrane risk of bias assessment tool( 5.1.0) to describe the development factors of patient decision aids and to qualitatively evaluate the intervention effects of outcome indicators. Results A total of 13 literatures were included referring to clinical decision such as medication, valve replacement, percutaneous coronary intervention( PCI) stent, chest pain examination and cardiovascular disease advance. Among 13 literatures, the overall quality is in the medium level including 3 with level A and 10 with level B. Qualitative analysis showed that:( i)In present period, development of patient decision aids mainly referred to the quality evaluation criteria published by the International Patient Decision Aids Collaboration, and core content of the tool included information support, advantages and disadvantages analysis of scheme as well as the clarification of patient values;( ii) in the application researches of patient decision aids, 11 of them improved patients' knowledge, 3 of them heightened risk perception and 3 of them promoted participation in decision-making. Conclusions Cardiovascular disease patient decision aids based on evidence-based structured decision support realizes the unification of best clinical evidence and patient values which helps improving patients' knowledge, risk perception and participation in decision-making and is an effective mean to carry out shared decision-making medical model.
作者
史润泽
弓宸
康晓凤
Shi Runze;Gong Chen;Kang Xiaofeng(School of Nursing,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100144,China)
出处
《中华现代护理杂志》
2019年第7期832-837,共6页
Chinese Journal of Modern Nursing
基金
中华护理学会2015-2016年度立项科研课题(ZHKY201517).
关键词
心血管疾病
患者决策辅助工具
医患共同决策
证据转化
系统评价
Cardiovascular diseases
Patient decision aids
Decision making of doctor-patient
Evidence transformation
Systematic review
