informed decision making

知情决策
  • 文章类型: Journal Article
    To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed.
    Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively.
    Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA\'s effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1).
    This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making.
    DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking.
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  • 文章类型: Journal Article
    Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people\'s decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two double-blind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening.
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  • 文章类型: Journal Article
    背景:医疗保健是一个知识驱动的过程,因此知识管理和医疗保健部门管理知识的工具正在受到关注。本系统综述的目的是调查医疗保健中用于知情决策的知识管理实施和知识管理工具。
    方法:三个数据库,两个期刊网站和谷歌学者被用作审查的来源。用于搜索相关文章的关键术语包括:“医疗保健和知识管理”;“医疗保健中的知识管理工具”和“医疗保健实践社区”。
    结果:发现在医疗保健中利用知识管理令人鼓舞。存在许多实施知识管理的机会,虽然也有一些障碍。可以改变医疗保健的一些机会是健康信息和通信技术的进步,临床决策支持系统,电子健康记录系统,实践社区和高级护理计划。
    结论:在正确的时间提供正确的知识,即,在医疗保健领域实施知识管理的决策至关重要。要做到这一点,使用适当的知识管理工具和用户友好系统非常重要,因为它可以显着提高医院和家庭环境中为患者提供的护理质量和安全性。
    BACKGROUND: Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making.
    METHODS: Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: \"Healthcare and Knowledge Management\"; \"Knowledge Management Tools in Healthcare\" and \"Community of Practices in healthcare\".
    RESULTS: It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning.
    CONCLUSIONS: Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.
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  • 文章类型: Journal Article
    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.
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