PDF(Pubmed)
Abstract：
Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition may decline. Shared decision-making, including the patient, family members, and healthcare providers, is critical to patient-centered care. The aim of this scoping review was to synthesize what is known about shared decision-making in persons living with dementia. A scoping review was completed in PubMed, CINAHL, and Web of Science. Keywords included content areas of dementia and shared decision-making. Inclusion criteria were as follows: description of shared or cooperative decision making, cognitively impaired patient population, adult patient, and original research. Review articles were excluded, as well as those for which the formal healthcare provider was the only team member involved in the decision-making (e.g., physician), and/or the patient sample was not cognitively impaired. Systematically extracted data were organized in a table, compared, and synthesized. The search yielded 263 non-duplicate articles that were screened by title and abstract. Ninety-three articles remained, and the full text was reviewed; 32 articles were eligible for this review. Studies were from across Europe (n = 23), North America (n = 7), and Australia (n = 2). The majority of the articles used a qualitative study design, and 10 used a quantitative study design. Categories of similar shared decision-making topics emerged, including health promotion, end-of-life, advanced care planning, and housing decisions. The majority of articles focused on shared decision-making regarding health promotion for the patient (n = 16). Findings illustrate that shared decision-making requires deliberate effort and is preferred among family members, healthcare providers, and patients with dementia. Future research should include more robust efficacy testing of decision-making tools, incorporation of evidence-based shared decisionmaking approaches based on cognitive status/diagnosis, and consideration of geographical/cultural differences in healthcare delivery systems.
摘要：
有证据表明，患有认知障碍的老年人可以可靠地传达他们的价值观和选择，即使认知能力可能下降。共同决策,包括病人,家庭成员,和医疗保健提供者，对于以患者为中心的护理至关重要。这项范围审查的目的是综合已知的痴呆症患者的共同决策。在PubMed中完成了范围审查，CINAHL,和WebofScience。关键词包括痴呆症和共享决策的内容领域。纳入标准如下：共同或合作决策的描述，认知障碍患者群体，成年患者,原创性研究。评论文章被排除在外，以及那些正式医疗保健提供者是参与决策的唯一团队成员的人(例如，医师)，和/或患者样本没有认知障碍。系统提取的数据被组织在一个表中，比较,和合成。搜索产生了263篇按标题和摘要筛选的非重复文章。剩下93篇文章，并对全文进行了审查；32篇文章符合本次审查的条件。研究来自欧洲各地(n=23)，北美（n=7），澳大利亚（n=2）。大多数文章采用了定性研究设计，10人采用了定量研究设计。出现了类似的共享决策主题类别，包括健康促进，生命的终结,高级护理计划，住房决策。大多数文章侧重于关于患者健康促进的共同决策（n=16）。研究结果表明，共同决策需要深思熟虑的努力，并且在家庭成员中更受欢迎，医疗保健提供者，和痴呆症患者。未来的研究应该包括对决策工具进行更稳健的功效测试，结合基于认知状态/诊断的循证共享决策方法，并考虑医疗保健提供系统中的地理/文化差异。
