目标:共享决策(SDM),整合的患者-提供者沟通过程,强调科学证据和患者/家庭价值观的讨论,可以提高护理质量,促进循证实践,减少过度使用外科护理。鲜为人知,然而,关于选择性外科实践中的SDM。本系统综述的目的是综合评估SDM在选择性手术中的使用和结果的研究结果。
方法:PubMed,科克伦中部,EMBASE,CINAHL,和SCOPUS电子数据库。
方法:我们搜索了英语研究(1990年1月1日至2015年8月9日),评估SDM在可以确定手术选择的择期外科护理中的应用。确定的研究由2名审稿人在标题/摘要和全文审查阶段进行独立筛选。我们提取了与人口有关的数据,研究设计,临床困境,使用SDM,结果,治疗选择,和偏见。
结果:在10,929篇确定的文章中,24符合纳入标准。研究的最常见区域是脊柱(24个中的7个),其次是关节(24个中的5个)和妇科手术(24个中的4个)。20项研究使用了决策辅助工具或支持工具,包括多媒体/视频模式(20个中的13个),写作(20个中的3个),或个人教练(20个中的4个)。SDM对手术偏好的影响在研究中喜忧参半,显示手术减少(24个中的9个),没有区别(24个中的8个),或增加(24个中的1个)。SDM倾向于提高决策质量(3个中的3个)以及知识或准备(6个中的4个),同时减少决策冲突(6个中的4个)。
结论:SDM减少了选择择期手术的患者的决策冲突,提高了决策质量。虽然净研究结果表明,SDM可能影响患者选择手术的频率较低,不能清楚地确定SDM对手术利用率的影响。
OBJECTIVE: Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SDM in elective surgical practice. The purpose of this systematic
review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery.
METHODS: PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases.
METHODS: We searched for English-language studies (January 1, 1990, to August 9, 2015) evaluating use of SDM in elective surgical care where choice for surgery could be ascertained. Identified studies were independently screened by 2 reviewers in stages of title/abstract and full-text
review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias.
RESULTS: Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7 of 24), followed by joint (5 of 24) and gynecologic surgery (4 of 24). Twenty studies used decision aids or support tools, including modalities that were multimedia/video (13 of 20), written (3 of 20), or personal coaching (4 of 20). Effect of SDM on preference for surgery was mixed across studies, showing a decrease in surgery (9 of 24), no difference (8 of 24), or an increase (1 of 24). SDM tended to improve decision quality (3 of 3) as well as knowledge or preparation (4 of 6) while decreasing decision conflict (4 of 6).
CONCLUSIONS: SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.