Abstract：
BACKGROUND: Decision aids (DAs) have been proposed to support patients and families with disease information processing and decision-making, but their effectiveness for critically ill patients and their families is incompletely understood.
OBJECTIVE: To systematically synthesize evidence on the effectiveness of the DAs on the prognosis of critically ill patients and knowledge, anxiety, depression and decisional conflict of their family members.
METHODS: Systematic review and meta-analysis. We conducted a systematic search of literature using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature database, Scopus, PsycNet, CNKI and Wanfang Database from the inception of the databases until May 2023 to identify randomized clinical trials (RCTs) describing DAs interventions targeted at adult intensive care unit (ICU) patients or their families. We also searched grey literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey and GreyNet International.
RESULTS: Seven RCTs were included in the review. Meta-analysis identified longer hospital length of stay (LOS) among all patients compared with usual care (mean difference [MD] = 5.64 days, 95% confidence interval, CI [0.29, 10.98], p = .04), but not in surviving patients (MD = 2.09 days, 95% CI [-3.70, 7.89], p = .48). However, there was no evidence of an effect of DAs on hospital mortality (RR = 1.25, 95% CI [0.92, 1.70], p = .15), ICU LOS (MD = 3.77 days, 95% CI [-0.17, 7.70], p = .06) and length of mechanical ventilation (MD = 0.88 days, 95% CI [-2.22, 3.97], p = .58). DAs led to a statistically significant improvement in family members\' knowledge (standard mean difference = 0.84, 95% CI [0.12, 1.56], p = .02). We found no significant effect of DAs on anxiety, depression, post-traumatic stress disorder, decisional conflict and quality of communication of family members.
CONCLUSIONS: This review provides effective evidence that DAs can potentially improve the knowledge level of family members while prolonging the hospital LOS among critically ill patients.
CONCLUSIONS: Well-designed large-scale studies with DAs tailored to the individuals\' preferences and existing cultural values are warranted.
OBJECTIVE: To systematically synthesize evidence on the effectiveness of the DAs on the prognosis of critically ill patients and knowledge, anxiety, depression and decisional conflict of their family members.
METHODS: Systematic review and meta-analysis. We conducted a systematic search of literature using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature database, Scopus, PsycNet, CNKI and Wanfang Database from the inception of the databases until May 2023 to identify randomized clinical trials (RCTs) describing DAs interventions targeted at adult intensive care unit (ICU) patients or their families. We also searched grey literature in four databases: Chinese Clinical Trials Registry, Chinese Cochrane Center, Open Grey and GreyNet International.
RESULTS: Seven RCTs were included in the review. Meta-analysis identified longer hospital length of stay (LOS) among all patients compared with usual care (mean difference [MD] = 5.64 days, 95% confidence interval, CI [0.29, 10.98], p = .04), but not in surviving patients (MD = 2.09 days, 95% CI [-3.70, 7.89], p = .48). However, there was no evidence of an effect of DAs on hospital mortality (RR = 1.25, 95% CI [0.92, 1.70], p = .15), ICU LOS (MD = 3.77 days, 95% CI [-0.17, 7.70], p = .06) and length of mechanical ventilation (MD = 0.88 days, 95% CI [-2.22, 3.97], p = .58). DAs led to a statistically significant improvement in family members\' knowledge (standard mean difference = 0.84, 95% CI [0.12, 1.56], p = .02). We found no significant effect of DAs on anxiety, depression, post-traumatic stress disorder, decisional conflict and quality of communication of family members.
CONCLUSIONS: This review provides effective evidence that DAs can potentially improve the knowledge level of family members while prolonging the hospital LOS among critically ill patients.
CONCLUSIONS: Well-designed large-scale studies with DAs tailored to the individuals\' preferences and existing cultural values are warranted.
摘要：
背景：已经提出了决策辅助（DA）来支持患者和家庭进行疾病信息处理和决策，但是它们对危重病人及其家属的有效性尚不完全清楚。
目的：为了系统地综合关于DA对危重患者预后和知识的有效性的证据，焦虑,家庭成员的抑郁和决策冲突。
方法：系统评价和荟萃分析。我们使用PubMed进行了系统的文献检索，Embase,科克伦图书馆,WebofScience,护理和相关健康文献数据库的累积指数，Scopus,PsycNet,CNKI和万方数据库从数据库开始到2023年5月，以确定描述针对成人重症监护病房（ICU）患者或其家人的DA干预措施的随机临床试验（RCT）。我们还在四个数据库中搜索了灰色文献：中国临床试验注册中心，中国科克伦中心，打开灰色和GreyNet国际。
结果：7项RCTs纳入本综述。荟萃分析确定与常规治疗相比，所有患者的住院时间（LOS）更长（平均差异[MD]=5.64天，95%置信区间,CI[0.29,10.98]，p=.04)，但在存活的患者中没有（MD=2.09天，95%CI[-3.70，7.89]，p=.48）。然而,没有证据表明DAs对医院死亡率有影响(RR=1.25，95%CI[0.92，1.70]，p=.15)，ICULOS（MD=3.77天，95%CI[-0.17，7.70]，p=.06）和机械通气时间（MD=0.88天，95%CI[-2.22，3.97]，p=.58）。DAs导致家庭成员知识的统计学显著改善(标准平均差=0.84，95%CI[0.12，1.56]，p=.02）。我们发现DAs对焦虑没有显著影响，抑郁症,创伤后应激障碍,家庭成员的决策冲突和沟通质量。
结论：本综述提供了有效的证据，证明在延长危重病患者的住院LOS的同时，DAs可以潜在地提高家庭成员的知识水平。
结论：有必要进行精心设计的大规模研究，并根据个人偏好和现有文化价值观量身定制DA。
目的：为了系统地综合关于DA对危重患者预后和知识的有效性的证据，焦虑,家庭成员的抑郁和决策冲突。
方法：系统评价和荟萃分析。我们使用PubMed进行了系统的文献检索，Embase,科克伦图书馆,WebofScience,护理和相关健康文献数据库的累积指数，Scopus,PsycNet,CNKI和万方数据库从数据库开始到2023年5月，以确定描述针对成人重症监护病房（ICU）患者或其家人的DA干预措施的随机临床试验（RCT）。我们还在四个数据库中搜索了灰色文献：中国临床试验注册中心，中国科克伦中心，打开灰色和GreyNet国际。
结果：7项RCTs纳入本综述。荟萃分析确定与常规治疗相比，所有患者的住院时间（LOS）更长（平均差异[MD]=5.64天，95%置信区间,CI[0.29,10.98]，p=.04)，但在存活的患者中没有（MD=2.09天，95%CI[-3.70，7.89]，p=.48）。然而,没有证据表明DAs对医院死亡率有影响(RR=1.25，95%CI[0.92，1.70]，p=.15)，ICULOS（MD=3.77天，95%CI[-0.17，7.70]，p=.06）和机械通气时间（MD=0.88天，95%CI[-2.22，3.97]，p=.58）。DAs导致家庭成员知识的统计学显著改善(标准平均差=0.84，95%CI[0.12，1.56]，p=.02）。我们发现DAs对焦虑没有显著影响，抑郁症,创伤后应激障碍,家庭成员的决策冲突和沟通质量。
结论：本综述提供了有效的证据，证明在延长危重病患者的住院LOS的同时，DAs可以潜在地提高家庭成员的知识水平。
结论：有必要进行精心设计的大规模研究，并根据个人偏好和现有文化价值观量身定制DA。
